Thyroiditis

This inflammatory thyroid disease has been first described in pregnant women who develop this in the postpartum period in about 8%. The natural course of the disease is a thyroid enlargement where the blood tests show hyperthyroidism. This lasts for a period of several weeks and is then followed by a period of normal thyroid function.

Some patients stay stable, but others get the late complication, which consists of hypothyroidism. We know from biopsy studies that Hashimoto's thyroiditis is an autoimmune disease where lymphocytes invade the thyroid gland.

The postpartum thyroiditis is usually more silent and disappears faster. Hashimoto's thyroiditis has a ratio of 8:1 with regard to occurrence in women versus men. It is more frequent in the older generation and particularly in elderly women. It is often only diagnosed when hypothyroidism occurs. Thyroid autoimmune disease is associated with other autoimmune diseases such as rheumatoid arthritis, lupus, Sjogren's syndrome and pernicious anemia. Diabetes mellitus, adrenal insufficiency and hypoparathyroidism are also associated with Hashimoto's thyroiditis. Later in life these patients have an increased frequency of thyroid cancers, particularly the papillary thyroid cancer and thyroid lymphoma.

Thyroiditis symptoms:

Diagnostic tests:

In the beginning of the disease Hashimoto's thyroiditis patients have normal T4 and TSH tests, but very high thyroid peroxidase antibodies with occasional positive antithyroglobulin antibodies. Later, during the hypothyroid phase, the tests are accordingly (low T4, high TSH and decreased thyroid uptake test).

Treatment:

Treatment requires lifelong thyroid replacement therapy with thyroid hormone as the TSH level, which causes thyroid cancer, must be suppressed. Thyroid replacement decreases the goiter size and normalizes the hypothyroidism. At the same time the pituitary gland stops overpoducing TSH as the negative feedback loop shuts down TRH production in the hypothalamus and TSH production in the anterior pituitary gland (see introduction to this chapter). This will help thyroid cancer prevention later in life. For more info on Hashimoto's thryoiditis click here.

Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

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Last Modified: Jan.29, 2008