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Thyroiditis

Thyroiditis is an inflammation of the thyroid gland. There are acute thyroiditis (purulent and non-purulent), subacute thyroiditis, chronic nonspecific thyroiditis (lymphomatous thyroiditis Hashimoto, fibroid thyroiditis Riedel) and extremely rare chronic specific thyroiditis: tuberculous, syphilitic, fungal. The cause of non-specific thyroiditis can be autoimmune changes in the body (Hashimoto goiter ), rarely an overdose of iodine preparations. More often women at the age of 30 - 50 years are ill.

Acute purulent thyroiditis is characterized by enlargement of the thyroid gland, redness of the skin, fluctuation at the site of the pus and localized tenderness to palpation in the neck, high temperature, changes in the blood picture (increase in the number of leukocytes, acceleration of ESR , leukocyte shift to the left). Treatment: antibacterial ( penicillin and other broad-spectrum antibiotics) and surgical. The prognosis is favorable when treatment started in a timely manner.

Acute nonpurulent and subacute thyroiditis is manifested by an increase and tenderness of the thyroid gland, fever, leukocytosis, and accelerated ESR. The histological picture of the nerve disease is characterized by inflammatory changes, the second - with giant cell granuloma. Acute non-suppurative thyroiditis is successfully treated with antibiotics (penicillin and other broad-spectrum antibiotics), with subacute - only glucocorticoids ( prednisone and others) are effective. With timely treatment started, the disease ends with recovery, and an outcome in hypothyroidism is possible.

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Lymphomatous thyroiditis Hashimoto is an autoimmune disease. The thyroid gland is enlarged, very dense, mobile; the phenomena of hypothyroidism (see), the temperature is normal. Usually the disease flows for a long time. Treatment: thyroid drugs, intermittent cycles of glucocorticoids. If you suspect a malignancy - surgery.

When fibroid thyroiditis Riedel thyroid gland is even more dense, often there are symptoms of compression of the upper respiratory tract. The disease lasts for a long time. Treatment is prompt.

In chronic specific thyroiditis, the thyroid gland is dense, painless, mobile. The diagnosis of chronic tuberculosis thyroiditis is made in the presence of a tuberculosis process in other organs or on the basis of biopsy data; syphilitic thyroiditis - based on serological reactions. Treatment of specific thyroiditis is reduced to the treatment of the underlying disease. See also Goiter .

Thyroiditis is an inflammation of the thyroid gland. There are acute, subacute and chronic thyroiditis. More often the inflammatory process covers the entire gland, less often the right lobe, even less often the left lobe or isthmus. Inflammation often moves from one site to another.

The etiology is different. Most often, the disease is caused by influenza, measles, scarlet fever, diphtheria, typhoid, etc. Thyroiditis can develop with tuberculosis, syphilis, gonorrhea, as well as with chronic tonsillitis, paraproctitis, rheumatism. Sometimes the cause of thyroiditis remains unknown. The infection penetrates the thyroid tissue through the lymphatic and blood vessels from the upper respiratory organs and from other parts of the body, as well as from organs in contact with the gland.

Known thyroiditis, which developed as a result of intoxication with iodine or lead, as well as as a result of transmission by bedbugs through the bite of Trypanos Cruz (Chagas thyroiditis). Perhaps the development of thyroiditis from wearing close collars.

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In acute thyroiditis, parenchymal inflammation with hyperplasia of the parenchyma and subsequent proliferation of connective tissue develops in the thyroid gland. Among the clinical manifestations of the disease should be noted general and local. Common manifestations are expressed in weakness, malaise, often in chills, aching pain in the joints, fever, sweating, headache. In the blood, moderate leukocytosis is detected with a shift of neutrophils to the left, acceleration of ESR. Sometimes the function of the thyroid gland increases. Local manifestations are expressed in pain syndrome during palpation of the thyroid gland and without it. Frequent pain in the ears, throat, lower jaw, an increase in the size of the gland.

Signs of developed suppuration can be reddening of the skin over the inflamed gland and more often a fluctuation.

The course of acute thyroiditis is rapid, up to 2–4 weeks, and the acceleration of ESR and subfebrile condition is noted up to 10–12 weeks. Complications are in the breakthrough of the abscess in the mediastinum (mediastinitis), hypothyroidism or thyrotoxicosis.

The diagnosis is made on the basis of the clinical picture. Thyroiditis is distinguished from acute tracheitis, suppuration of branhogenic and schistoichagous cysts, perichondritis of laryngeal cartilage, hemorrhage in the parenchyma of the neck, and phlegmon of the neck.

Treatment : antibiotics (penicillin, streptomycin, terramycin) in combination with sulfonamides, adrenocorticotropic hormone (20 IU 3-4 times a day), cortisone or prednisolone (30 mg per day); warming compresses, opening of the abscess.

Kerven thyroiditis (non-purulent thyroiditis). The cause of the disease is not known. Likely viral etiology. The temperature rises, there are severe pain in the thyroid gland, giving back to the nape, ears, and lower jaw. The nearby lymph nodes are not changed. The thyroid gland is swollen, dense, painful. Leukocytosis high, ROE accelerated. Microscopically observed hyperplasia of the epithelium, its infiltration with leukocytes, lymphocytes and plasma cells. Later comes fibrosis, sometimes with an increase in gland function. The disease lasts for several months.

Treatment: cortisone, hydrocortisone , prednisone or prednisone. The first 10–15 days give hydrocortisone at 0.030–0.040 per day, then at 0.015–0.020 per day until complete recovery, which is confirmed by normalization of ESR.

In other cases, radiotherapy is used or resorted to surgery.

Subacute thyroiditis is an independent disease that does not have a connection with acute thyroiditis. The reason is not known. Duration from 1-2 to 12 months. Symptoms resemble signs of acute thyroiditis, only its severity is less. The outcomes are the same.

Treatment: antibiotics, sulfonamides, ACTH from 20 to 40 units per day, prednisone 20-30 mg per day, vitamins, local heat, with treatment failure - radiotherapy (800 r for the thyroid gland), for compression of vital organs - surgical intervention .

Chronic fibrous thyroiditis Riedel (goiter Riedel, thyroiditis ligneous consistency). With this form of inflammation, the thyroid gland acquires a woody density, gradually increasing. Painful sensations and fever no. The gland is tightly soldered to the underlying tissues and inactive. Increased iron can squeeze vital organs.

Possible signs of hypothyroidism. The disease should be distinguished from thyroid cancer, which in some cases can only be done with a biopsy.

Treatment is prompt. Possible recurrence of the disease. Complication: hypothyroidism.

Chyroid thyroiditis of the Hashimoto type (Hashimoto goiter) occurs less frequently than Riedel's thyroiditis. The disease is more common in people suffering from goiter, mostly at the age of 40-60 years, more often in women. In thyroiditis, autoantibodies to thyroglobulin and thyroid epithelium are detected in serum, which give the reaction of complement binding and precipitation. This allows the disease to be classified as autoagressive, based on the denaturation of tissue proteins, the formation of autoantigens and the subsequent occurrence of autoantibodies specifically affecting the corresponding tissues.

The disease comes slowly. Clinical signs are minor, especially at the onset of the disease. The thyroid gland increases in size, becomes elastic and compact, patients complain of difficulty swallowing, breathing. The gland is not bound to the surrounding tissues, it is shifted when swallowed.

Radiological or surgical treatment. However, as a result of treatment, hypothyroidism often occurs.

The use of iodine is not shown. Thyreoidin has a beneficial effect. Prednisone only relieves suffering while taking it.