Thyroiditis

Thyroiditis ( thyroid inflammation, and thyroiditis ) is the technical term for an inflammation of the thyroid gland. The term encompasses several diseases of various causes, which differ partly strong in their clinical course and prognosis.

Classification

The thyroid disease can be classified in different ways. A common classification is according to the course of the disease: It can cause acute, subacute and chronic thyroiditis can be distinguished. In addition, classifications according to the character of the pain ( painless and painful thyroid inflammation ) as well as for the cause are common.

Acute thyroiditis

Acute thyroiditis may have different causes.

With an infectious thyroiditis there is an infection caused by bacteria, fungi and parasites. Upon infection by bacteria, the most common form of infectious thyroiditis, occurs within a few days to a painful suppurative thyroiditis with malaise, in which abscesses may form in the thyroid gland itself. It is also referred to as acute suppurative thyroiditis. With a share of less than 1 % of thyroid disease, acute suppurative thyroiditis is a rare condition.

In an iatrogenic thyroiditis is a thyroiditis caused by medical measures. An acute iatrogenic thyroiditis may occur after a fine needle aspiration after radiation, after radiotherapy and after surgery of the thyroid gland surrounding organs. The acute iatrogenic thyroiditis after radioiodine therapy or after radiation therapy is also known as Strahlenthyreoiditis.

As a result of metastasis of tumors and thyroid ( perineoplastisch ) can also develop an acute inflammatory response in thyroid tissue.

Subacute thyroiditis

Subacute thyroiditis was first described in 1904 by Fritz de Quervain. Its cause is still unknown to this day, is suspected a preceding viral infection. In this disease form in the tissues " giant cells ," which earned her therefore also the name Riesenzellenthyreoditis. Symptom is especially radiating to the ear, upper and lower jaw pain. The pain in the neck area frequently switch from one side to the other. In addition, patients suffering from general malaise, fever, lassitude and weakness, as in a severe viral infection. Here, the subacute thyroiditis usually goes with a time interval of a few weeks a chest infection ahead. By the inflammatory response, there is a damage to the thyrocytes. As a result, the thyroid hormone stores are emptied into the blood. Thyroid hormone concentration in the blood increases significantly. Complaints within the meaning of hyperthyroidism are the result. After this transient phase is followed by hypothyroidism, because the damaged thyroid tissue is no longer able to produce new thyroid hormones. The illness usually lasts 1-4 months rarely sometimes up to 6 months. By appropriate treatment, symptoms can be alleviated quickly. While a cause-specific therapy is not known, the symptoms by administration of salicylic acid or diclofenac with a slight or of glucocorticoids in severe thyroiditis are angehbar. The trial of the treatment of hormonal hyperfunction by antithyroid drugs is ineffective. After healing the thyroid gland retains its normal function normally. Sometimes a sub-function, which can be treated by the administration of thyroid hormone (L- thyroxine ) was developed.

Chronic thyroiditis

Chronic thyroiditis is an over the years running, painless disease that completely or partially destroys the tissue. The reasons for this are a genetic defect ( with familial clustering ) and an autoimmune disease. All the symptoms occur slowly and insidiously. Therefore, the disease is also usually discovered by chance. The therapy is tailored to the individual patient and the disease process. As a result of the disease, endocrine -functioning thyroid gland remains. Therefore, a lifelong substitution (the gift ) of thyroid hormones is necessary.

Hashimoto 's thyroiditis

Hashimoto's thyroiditis or Hashimoto's lymphomatous goiter is an increasing over the years, focal or diffuse lymphocytic and plasma cellular infiltration of the thyroid gland with formation of lymphoid follicles and germinal centers, which can be detected by cytology. It comes to fibrosis up to the disappearance of the Schilddrüsenparenchyms with simultaneous formation of a rough goiter without knots. This disease occurs most frequently in association with other autoimmune diseases (eg, myasthenia gravis, pernicious anemia, atrophic gastritis).

Hashimoto's thyroiditis takes a clinically normal course with a more or less pronounced hypothyroidism, possibly lymphocytosis and immunoglobulin proliferation. In the acute phase, a hyperthyroid metabolic control may occur ( " Hashi - toxicosis "). The thyroid antibodies TPO -Ab and TG -Ab are initially increased. Is treated mainly by the substitution treatment with thyroid hormone. Struma other causes must be ruled out, especially the Struma maligna ( thyroid cancer).

Graves' thyroiditis

The Grave's thyroiditis or Graves' disease is an autoimmune thyroiditis with clinical signs of hyperthyroidism in varying degrees of goiter diffuse parenchymatous, often in combination with thyroid eye disease and tachycardia (so-called Merseburg triad ). Graves' disease tends to be chronic course with spontaneous remissions and frequent relapses. An association with other autoimmune diseases is possible (eg, vitiligo, rheumatoid arthritis, Crohn's disease, diabetes mellitus type 1).

The thyroid antibodies TRAK is detectable in 60-80 % of untreated patients is often TPO -Ab and TGAK detectable. Graves' disease can be treated with anti-thyroid drugs in Rezidivhyperthyreosen possibly ablative therapy. The transitions between the individual Immunthyreopathien are fluent in part.

Postpartum thyroiditis

The Postpartum thyroiditis is an autoimmune thyroiditis in women during the first year after childbirth, often with subclinical hypothyroidism or hyperthyroidism and usually spontaneous remission. Occasionally there will be a transition to a Graves' disease or Hashimoto 's thyroiditis.

Invasive sclerosing thyroiditis

When invasive sclerosing thyroiditis, or Riedel struma the fibrosis of the thyroid gland goes beyond the body and includes the surrounding tissue and muscles with a ( perithyroidale thyroiditis ).

Specific thyroiditis

Specific thyroiditis occur, for example tuberculosis or sarcoidosis.