Chronic lymphocytic thyroiditis (CLT), also known as autoimmune thyroiditis, is a chronic inflammatory autoimmune disease that uses its own thyroid tissue as the antigen. It is the most common inflammatory thyroid disorder in clinical practice.
Clinical manifestations of typical cases.
1, the development is slow, the course of the disease is long, early can be asymptomatic, when the appearance of goiter, the average duration of the disease has reached 2 to 4 years.
2, common symptoms are generalized weakness, many patients do not have throat discomfort, 10% to 20% of patients have local pressure or vague pain in the thyroid area, and occasionally have light pressure pain.
3. The thyroid gland is mostly bilaterally symmetrical and diffusely enlarged, and the isthmus and conus lobe are often enlarged at the same time, or unilaterally.
4. The cervical lymph nodes are usually not enlarged, but in a few cases they may also be accompanied by enlarged cervical lymph nodes, but they are soft.
Disease diagnosis.
1, nodular goiter
2. Adolescent goiter
3.Graves’ disease
4, malignant tumor of the thyroid gland
5, chronic aggressive fibrous thyroiditis
Laboratory tests.
1.Thyroid function measurement
2.Serum TSH concentration measurement
3.131I absorption rate examination
4.Anti-thyroid antibody measurement
5.Potassium perchlorate excretion test positive, iodine release rate >10%.
6.Cytological examination
7.Other examinations Increased sedimentation, positive flocculence test, elevated gamma globulin IgG, elevated blood beta lipoprotein, and increased lymphocyte count.
Other auxiliary examinations.
1.B ultrasound examination
2.Color Doppler sonographic performance
3.Thyroid nuclear scan
4.Positron emission computerized imaging system
Treatment.
In principle, surgery is generally not recommended. After clinical diagnosis, treatment should be decided depending on the size of the thyroid gland and the presence or absence of symptoms of compression. If the thyroid gland is small and there are no obvious symptoms of compression, it can be observed without treatment for the time being, but if the thyroid gland is obviously enlarged and has symptoms of compression, treatment should be carried out.
1. Non-surgical treatment.
(1) Thyroxine treatment: When goiter is obvious or accompanied by hypothyroidism, thyroxine treatment can be given, using L-T4 or thyroid powder (tablets). Generally start with small doses, 40-60mg/d of thyroxine tablets and 100g/d of L-T450, and gradually increase the dose to 120-180mg/d or 100-200g/d, respectively, until the gland starts to shrink and TSH levels drop to normal. Thereafter, the dose is gradually adjusted according to the individual, and the dose is reduced to the maintenance amount according to the thyroid function and TSH level, and the course of treatment is usually 1 to 2 years. The drug can be discontinued when the goiter improves and thyroid function returns to normal.
(2) Anti-thyroid treatment: Hashimoto’s hyperthyroidism should be treated with anti-thyroid treatment with methimazole (Tabazol) or propylthiouracil (PTU), but the dose should be less than that for Graves’ disease, and the duration of medication should not be too long. In case of transient hyperthyroidism (clinically manifest), symptomatic treatment with only beta-blockers such as propranolol (Tazenol) or metoprolol (Betaxolol) may be used.
(3) Glucocorticoid therapy: for subacute onset, when thyroid pain and enlargement are obvious, prednisone (prednisone) (15-30mg/d) can be used for treatment, and the dosage will be gradually reduced after the symptoms improve for 1 to 2 months. Glucocorticoids can increase T3 and T4 levels by suppressing autoimmune reactions. However, the efficacy of prednisone is not long-lasting, and it is often easy to relapse after stopping the drug. Prednisone can be used again if the pain recurs. However, in cases of obvious hypothyroidism, the use of hormones is generally not recommended.
The specific medication should be combined with the clinical situation and guided by the doctor’s interview.
2.Surgical treatment.
After CLT is diagnosed, surgical treatment is rarely required. Many surgeries for CLT are performed because of clinical misdiagnosis as other thyroid disorders. A report on the effect of surgical treatment of CLT found that the incidence of clinical hypothyroidism and subclinical hypothyroidism in the surgical group was 93.6%, while the incidence in the non-surgical group was 30.8%, indicating that surgery aggravates the destruction of thyroid tissue and promotes the occurrence of hypothyroidism, therefore, the surgical indications should be strictly controlled.
(1) Indications for surgery.
① diffuse enlargement of the thyroid gland, combined with a single nodule with symptoms of compression.
(ii) Single nodule with cold nodules and suspected malignant change.
③ those with enlarged cervical lymph nodes with adhesions, with malignant lesions confirmed by FNAC or tissue biopsy
(iv) Those with marked enlargement of the thyroid gland, a long history of disease, poor results of medication, and their own request for surgery.
⑤ Those with ineffective thyroxine treatment for 2 to 3 months, with insignificant thyroid shrinkage and compression.
(2) Selection of surgical procedure.
Frozen section tissue biopsy should be routinely performed during surgery. If the disease is confirmed, only partial thyroid lobe resection or isthmus resection should be performed, the main purpose of which is to remove larger solitary nodules to relieve compression. As much repairable thyroid tissue as possible should be preserved. If a malignant tumor is diagnosed by pathology, it should be treated according to the principles of thyroid cancer management by total thyroidectomy or near-total thyroidectomy.