I. Symptoms What is thyroiditis? Thyroiditis is an inflammatory disease of the thyroid gland caused by viruses, bacteria, various physical and chemical factors and autoimmune reactions. Clinical manifestations are inconsistent and the thyroid gland can show symptoms ranging from hypofunction to an enlarged thyroid gland and symptoms similar to hyperthyroidism. It can be accompanied by systemic reactions of varying degrees. Causes What triggers thyroiditis? Thyroiditis is caused by the attack of various factors on the thyroid gland, leading to inflammation and destruction of thyroid cells. Anti-thyroid antibodies can cause most thyroiditis. Other factors include infection (viral, bacterial) or certain medications. III. Diagnosis 1. What are the clinical symptoms of thyroiditis? There are no specific symptoms of thyroiditis. If thyroiditis is causing slow destruction of thyroid cells, resulting in a drop in blood thyroid hormones, the clinical presentation is like hypothyroid symptoms. If thyroiditis is causing rapid thyroid cell destruction, hormones present in the thyroid gland leak out, raising blood thyroid hormone levels and producing thyrotoxicosis. As with hyperthyroidism manifestations, subacute thyroiditis may be seen as radiating pain in the anterior neck area and tenderness in the thyroid area. 2. Types and clinical stages of thyroiditis Hashimoto’s thyroiditis – Patients often have hypothyroidism, and it is permanent. Subacute thyroiditis, painless and postpartum thyroiditis – These thyroiditis are associated with hypothyroidism and thyrotoxicosis. Thyrotoxicosis usually lasts 1-3 months and symptoms include: anxiety, insomnia, palpitations, fatigue, weight loss, and irritability. The pain of subacute thyroiditis accompanies the thyrotoxic phase. The typical manifestations of the hypothyroid phase usually appear 1-3 months after the thyrotoxic phase and last 9-12 months. Typical manifestations include fatigue, weight gain, constipation, dry skin, depression, and decreased exercise tolerance. The majority (80-95%) of patients return to normal 12-18 months after the onset of the disease. 3. Drug and radiation thyroiditis – In both lesions hypothyroidism and thyrotoxicosis can be seen. Thyrotoxicosis is usually shorter, drug-induced hypothyroidism usually resolves with discontinuation of the drug, and radiographic hypothyroidism is usually permanent. 4. Acute infectious thyroiditis – includes thyroid pain, systemic disease, painless enlargement of the thyroid gland and hypothyroidism, symptoms usually resolve after the infection is controlled. IV. Treatment How is thyroiditis treated? Treatment depends on the type of thyroiditis and the clinical presentation. Thyrotoxicosis – Beta-blockers help relieve palpitations and paroxysms. Anti-hyperthyroid drugs are not indicated in the toxic phase of thyroiditis because the thyroid gland is not functioning at a high level. Hypothyroidism – Hashimoto’s thyroiditis is treated with thyroid hormones (replacement therapy). In the treatment of subacute thyroiditis, painless thyroiditis, and postpartum thyroiditis, thyroid hormone should be continued for about 6-12 months, followed by checking whether thyroid hormone is permanently needed. Thyroid pain – mild anti-inflammatory medications are applied for thyroid pain in subacute thyroiditis. For example: aspirin, ibuprofen. Usually prednisone treatment is needed when this disease is very severe