The term thyroiditis is used for a group of individual conditions, in which the main feature is inflammation of the thyroid. Different conditions included in this group are prevalent in different countries and may be painful or painless. For example, Hashimoto’s thyroiditis is prevalent in the US and is a painless condition. Other types of thyroiditis include:
- Subacute thyroiditis (de Quervain’s thyroiditis)
- Silent thyroiditis (a painless condition)
- Post partum thyroiditis
- Drug induced thyroiditis
- Radiation induced thyroiditis
- Acute thyroiditis (suppurative thyroiditis)
The various conditions of thyroiditis do not have their own clinical features; their signs and symptoms are either those of hypothyroidism (reduced activity of the thyroid) or hyperthyroidism (increased activity of the thyroid). If the disease causes gradual destruction of the thyroid gland, leading to a gradual reduction of thyroid hormone in blood, the patient will show signs and symptoms of hypothyroidism: fatigue, weight gain, constipation, dry skin, depression and poor exercise tolerance. On the other hand, if the disease causes rapid destruction of the gland, the hormone stored in it will leak and cause a high level of thyroid hormone in the blood, resulting in the signs and symptoms of hyperthyroidism, such as, anxiety, insomnia, palpitations (fast heart rate) fatigue, weight loss and irritability. The symptoms of hyperthyroidism are similar to thyrotoxicosis, which occurs in these ailments. Then again, in some conditions the initial hyperthyroid symptoms may change to hypothyroid symptoms, after the hormone stores are depleted. The extent of hypoactivity or hyperactivity of the gland in each of these conditions is given below:
- Hashimoto’s thyroiditis: formation of antibodies against the thyroid gland, cause unknown, symptoms of hypothyroidism, rare cases of transient thyrotoxicosis
- Subacute thyroiditis : the causative agent is probably a virus; it is painful and resolves in most people after 12-18 months, with little chance of recurrence; painful thyroid, symptoms of thyrotoxicosis, followed by hypothyroidism; de Quervain’s thyroiditis
- Silent thyroiditis: a painless condition; occurs in both men and women; symptoms of thyrotoxicosis, followed by hypothyroidism
- Post partum thyroiditis : occurs in women after delivery of a baby; symptoms of thyrotoxicosis, followed by hypothyroidism
- Drug induced thyroiditis: caused by certain drugs; symptoms of either thyrotoxicosis or hypothyroidism
- Radiation induced thyroiditis: caused by radioactive treatment for hyperthyroidism and certain thyroid cancers; occasionally, symptoms of thyrotoxicosis; more frequently, hypothyroidism
- Acute thyroiditis; also called suppurative thyroiditis; usually caused by bacteria, but can be caused by other organisms as well; occasional symptoms of painful thyroid, generalized illness, occasional mild hypothyroidism
Thyroiditis can be caused by a number of different agents, the most common of which is an auto antibody. These are antibodies created by the body to fight against its own tissues or glands, causing inflammation. The reason for the formation of these antibodies by a few people in any population is not known; however, their formation is thought to be genetic. There are other agents that cause inflammation of the gland as well, including certain bacteria; viruses; and even drugs, such as, interferon, amiodarone, lithium and cytokines. These drugs can damage cells of the thyroid gland, thus causing inflammation similar to that caused by the auto antibodies.
Diagnosis and Treatment
The tests generally used to diagnose the different conditions of thyroiditis are thyroid function tests, thyroid antibody tests and radioactive iodine uptake.
Treatment for thyrotoxicosis or hyperthyroid symptoms: beta blockers are used to control some symptoms.
Treatment for hypothyroid symptoms: thyroid hormone therapy is required for 6-12 months, and then tapered off to assess future need for drugs.
Treatment for painful conditions of thyroiditis: Moderate pain can be controlled by anti inflammatory drugs, whereas severe pain is treated with steroids.
Sometimes, surgery is also an option.
Alternative remedies are also available, in the form of herbal, homeopathic, acupuncture and nutritious treatments for both hypo and hyperthyroid symptoms.