Thyroid

Subacute Lymphocytic Thyroiditis

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Subacute Lymphocytic Thyroiditis, Silent Sporadic Thyroiditis, Painless Sporadic Thyroiditis, Silent Thyroiditis

  • Pathophysiology
  1. Autoimmune lymphocytic infiltration of Thyroid
  2. Results in Thyroid follicle destruction with release of preformed Thyroid hormone
  • Epidemiology
  1. More common in women by 4 fold
  • Signs
  1. Painless Goiter (50%)
  2. Hyperthyroidism (up tp 20%)
    1. Duration: Typically <4 months
    2. Followed by Hypothyroidism and then euthyroid
  • Differential Diagnosis
  • Labs
  1. Thyroid Function Tests (T4 Free and TSH)
  2. Antibodies
    1. Antithyroid Peroxidase Antibody or TPO Antibody (positive in 50%)
    2. Thyroid Stimulating Immunoglobulins absent
      1. Contrast with Grave's Disease
  • Imaging
  1. Radioiodine Uptake (Thyroid uptake and scan)
    1. Low uptake (contrast with Grave's Disease)
  • Management
  1. Beta Blockers (e.g. Propranolol)
    1. Indicated for Hyperthyroidism symptoms
  2. Levothyroxine
    1. Indicated for symptomatic Hypothyroidism or persistent, chronic Hypothyroidism
  • Course
  1. Resolves within 12 months (up to 18 months) in 89% of cases
  2. Hypothyroidism persists chronically in 11% of cases
  3. Recurrence is uncommon