Inflammation of the thyroid gland
introduction
The Inflammation of the thyroid gland, also Thyroiditis called, is a generic term for a group of diseases with different causes, prognoses and courses, all of which are based on an inflammation of the thyroid gland.
The German Society for Endocrinology differentiates the thyroid inflammation into three classes:
- acute thyroiditis
- subacute thyroiditis (de Quervain)
- the chronic thyroiditis
However, all forms of thyroid inflammation are today well treatable and if diagnosed early enough, there is a very low risk of complications and consequential damage.
Acute thyroiditis
The acute thyroiditis is a very rare form of thyroiditis. It is classified again in the purulent and non-purulent acute thyroiditis.
Symptoms
The symptoms of acute thyroiditis do not differ in their subtypes.
In general, the typical symptoms of inflammatory diseases appear. The body reacts to the infection with a fever, the area of the thyroid gland on the neck is swollen and red.
There is also pain in the thyroid gland, which can also be felt from the outside due to the swelling.
Read about this too Thyroid pain
root cause
Acute thyroiditis is classified based on its cause.
The purulent thyroiditis is through bacterial pathogens evoked. Usually the thyroid inflammation is one Inflammation of nearby structures, such as. of the Almonds moving forward even if Bacteria in the blood this can lead to an inflammation of the thyroid gland.
The non-purulent thyroiditis will mostly radiation-related caused. So it happens in about 1% of cases after a so-called Radioiodine therapy acute inflammation of the thyroid gland, as well as a Radiation therapy of a tumor or similar be causative.
therapy
Acute thyroiditis is treated symptom and cause-oriented. The first piece of advice is of course to stay in bed to strengthen your body and support your own immune system.
For pain relief, a "Ice tie“, And also with so-called Anti-inflammatory drugs treated, drugs that have both pain relieving and anti-inflammatory effects. To combat the bacterial pathogens, antibiotics are also used.
In rare cases there is accompanying hyperthyroidism (excessive hormone production by the thyroid gland), which can be managed well by giving so-called beta-receptor blockers.
diagnosis
The diagnosis of acute thyroiditis is made based on the patient's physical examination and laboratory tests. The signs of inflammation fever, redness, swelling and pain over the thyroid gland are very typical of acute thyroid inflammation.
One falls in the laboratory Increase in blood sink speed on, an increase in the Inflammatory parameter C-reactive proteinand an increased number of white blood cells (Leukocytosis) with an increased number of very young white blood cells (Left shift).
If a blood smear is also made, an increased number of granulocytes, specialized white blood cells and bacteria are particularly noticeable.
The gold standard for confirming the diagnosis is fine needle aspiration, also known as fine needle biopsy. A small piece of tissue is removed from the thyroid gland and examined under a microscope in the laboratory.
Read on under: Thyroid biopsy
forecast
Acute thyroiditis has a very good prognosis, with a rapid and adequate diagnosis and effective antibiotic therapy, a decrease and complete healing of the disease within a few days can be seen.
Subacute thyroiditis (de Quervain)
The one after the Swiss Fritz de Quervain (1868-1941) also called Quervain's thyroiditis or Thyreoiditis de Quervain inflammation of the thyroid gland is also an inflammatory tissue disease of the thyroid gland, although it is somewhat slower disease course (subacute) and shows symptoms other than acute thyroiditis. The origin of the disease has not yet been clarified in detail.
Symptoms
Subacute thyroiditis begins with local, severe pain in the thyroid gland which, as the disease progresses, can radiate towards the head and ear or towards the chest. Typically, an accompanying general feeling of illness and weakness occurs, which becomes stronger as the disease becomes more severe.
Possible symptoms are also headache, fever, muscle pain and clinical signs of an overactive thyroid (restlessness, sweating, sleep problems, tremors, weight loss).
root cause
The mechanism by which subacute thyroid inflammation develops is not yet properly understood. However, it is often associated with viral infections, e.g. after virus-related pneumonia, mumps, etc. and is therefore referred to as parainfectious.
therapy
Therapy for subacute thyroiditis is purely symptomatic and depends on the severity of the symptoms. With milder forms of the disease, the so-called non-steroidal anti-rheumatic drugs (Anti-inflammatories) such as ibuprofen.
For more severe courses, therapy with glucocorticoids (Prednisone, cortisone) to combat systemic inflammation. Here, a high single dose of glucocorticoids is used, which is then reduced by 20% every 1-2 weeks until it is completely tapered off.
Here, too, hyperthyroidism can occur in the course of the disease, which is again treated with beta-receptor blockers.
diagnosis
This also occurs in subacute thyroiditis diagnosis mostly based on the appearance and complaints of the patient like that general malaise with increasing weakness in combination with the pain radiating from the thyroid towards the head and chest.
To confirm the diagnosis, a Blood test arranged, here an increased Blood sink speed and an increase in the C-reactive protein. In comparison to an autoimmune disease of the thyroid gland, there are no endogenous antibodies against the thyroid cells.
Usually there is also a Thyroid sonography carried out, here it is spotty and inhomogeneous.
If the diagnosis is still unclear, a fine needle puncture can again be used, which shows typical long-necked giant cells, specialized phagocytes of the body, under the microscope.
forecast
The duration of subacute thyroid inflammation is longer than that of acute thyroiditis and can last for several months to a year.
Depending on how much tissue of the thyroid gland has been destroyed by the inflammation, there is a temporary hypothyroidism which, however, decreases again as the disease severity decreases and only has to be treated with medication in 2-5% of cases.
Despite the length of the inflammation, the prognosis is very good and the thyroiditis heals completely.
Chronic thyroiditis (Hashimoto's thyroiditis)
In the chronic thyroiditis according to Hashimoto is it a Autoimmune disease, i.e. a disease in which the body's own cells mistakenly attack other functional cells. This process takes place in the thyroide takes place slowly and is irreversible, however, the function of the thyroid gland can be replaced with drugs very easily and without great effort.
Symptoms
Chronic thyroid inflammation of the Hashimoto type lasts for a long time without real symptoms, as the destruction of the thyroid cells takes place slowly and the loss of function only becomes manifest when there is a large number of cells. If too many cells perish to maintain normal thyroid function, hypothyroidism occurs with its typical symptoms such as general tiredness and weakness, weight gain, constipation, increased feeling of cold, slowing of the reflexes, rheumatic complaints, swelling of the skin, in particular good to see on the eyelids, muscle cramps and decreases in potency.
root cause
In chronic thyroiditis according to Hashimoto, the thyroid gland is activated by the body's own cells of the immune system (T lymphocytes and plasma cells), these cause the destruction of the functioning thyroid cells (Thyrocytes).
As with other auto-immune diseases (Basedow's disease et.al.), the exact reason for the attack on the body's own cells is not yet fully understood.
therapy
Due to various factors, no special therapy is indicated for chronic thyroiditis until hypothyroidism occurs.
The course of the disease is symptom-free, no symptom-oriented therapy is necessary. The destruction of thyroid cells cannot be treated with medication either, as the side effects on the general immune system would be too serious. In addition, the final stage, hypothyroidism, is given once a day with levo-thyroxine in tablet form very patient-friendly, few side effects and easy to adjust.
The therapy therefore consists of a therapy for the hypothyroidism resulting from the chronic inflammation.
diagnosis
The diagnosis of chronic thyroid inflammation is made relatively late in the course of the disease due to the lack of symptoms. It is then based on the appearance of the patient who has the symptoms of hypothyroidism described above (Hypothyroidism) having. The diagnosis is confirmed on the basis of the blood count, in which a targeted search is made for thyroid hormones and antibodies against the thyroid gland. The thyroid hormones are lowered despite the increased thyroid drive hormone "TSH“, Furthermore so-called Anti-TPO antibodies in front.
In addition, the diagnosis can also be confirmed via ultrasound of the thyroid gland, here the thyroid appears hypoechoic, meaning that there is only little functional tissue left.
forecast
Despite the dangerous sounding "Final course“The prognosis of chronic thyroiditis is very good, and only dangerous for the patient if the thyroid is untreated.
If the thyroid hormones are replaced in tablet form, the patients are to be regarded as healthy.
prophylaxis
A general prophylaxis of thyroid inflammation is unfortunately not possible. Bacterial and viral infections of the thyroid gland cannot be prevented, and the auto-immune infection of the thyrocytes cannot be deliberately prevented or influenced either.
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