Subacute thyroiditis, whose treatment and symptoms differ from other forms of thyroid disease, is rare. It is also called de Quervain ‘s thyroiditis . It is characterized by inflammation of the thyroid gland, which eventually destroys the tissues of the organ. In subacute thyroiditis, a large amount of hormones are released into the bloodstream, which provokes a general intoxication of the body. It is still unclear what causes it to appear. There is a hypothesis that it provokes viruses, but it develops in people with a genetic predisposition to the disease.

Symptoms

Subacute thyroiditis can begin acutely: with a rise in temperature to 38⁰С, the appearance of pain in the front of the neck, which can radiate to the ears, occipital region, lower jaw, pain when swallowing. General well-being suffers, the patient has impotence.

But more often the first signs of subacute thyroiditis are mild, and it develops gradually. At an early stage, the patient’s symptoms may be only a slight weakness, sipping in the neck, discomfort when swallowing, when chewing solid food. Pain is observed when changing the position of the head, with palpation of the thyroid gland. On the one hand, the thyroid gland is enlarged in size, while, as a rule, the lymph nodes are of normal size.

In addition, in some patients, subacute thyroiditis may be accompanied by the following symptoms:

• excessive sweating,
• cardiopalmus,
• arthralgia,
• sleep disorder,
• trembling of the fingers.

Almost 50% of patients develop symptoms of mild to moderate thyrotoxicosis. When a large amount of thyroid hormone enters the bloodstream, the production of TSH, which regulates thyroid function, decreases in the brain.

TSH deficiency becomes the reason that the part of the organ that has not suffered from pathology reduces its functionality and, with the progression of thyroiditis, hypothyroidism develops, lasting a maximum of 6 months. After this time, the level of hormones returns to normal.

Diagnostics

The diagnosis is made on the basis of anamnesis, existing symptoms, visual examination, and research results. It is important to tell your doctor about a recent viral infection.

To make a diagnosis, the following tests and examinations are prescribed:

• a clinical blood test that will show an increased ESR, which indicates the presence of inflammation in the body;
• blood for thyroid hormones;
• Ultrasound and scintigraphy of the thyroid gland.

It also helps in diagnosing the appointment of glucocorticosteroids , which stop the symptoms of inflammation – with this form of thyroiditis, during the first 12-48 hours after the start of treatment, there is a decrease in pain in the neck, an improvement in general condition, and a decrease in ESR.

It is important to differentiate the pathology from acute thyroiditis, Graves’ disease, and thyroid cancer. Since subacute thyroiditis is a disease with a relapsing course, it is necessary to undergo regular examinations to identify the pathology.

Treatment

Subacute thyroiditis of the thyroid gland is treated medically and surgically. Only an endocrinologist should choose therapy after the examination.

To eliminate inflammation , glucocorticosteroids are prescribed . As a rule, treatment with prednisolone is prescribed. The daily dosage can be 6-8 tablets, more than half of which should be taken in the morning. The duration of treatment is selected individually depending on the patient’s well-being and the results of the examination.

If the symptoms of thyroiditis subside, the dose of prednisolone is gradually reduced and switched to a maintenance daily dosage. In parallel with prednisolone, non-steroidal anti-inflammatory drugs are prescribed and gradually completely abandon the glucocorticosteroid . If after its cancellation there is a recurrence of thyroiditis, then prednisolone is prescribed again.

Dexamethasone and Kenalog are also used for treatment . They are injected directly into the thyroid gland once every 7 days.

Hormones are taken, as a rule, within two months, but if the pathology recurs, the treatment is extended to 6 months. But in this case, there is a risk of developing hypertension, diabetes, weight gain.

NSAIDs (non-steroidal anti -inflammatory drugs) help only with mild thyroiditis, so they are rarely prescribed, Indomethacin is preferred, Ortofen is prescribed for pain relief .

To eliminate the symptoms of inflammation, compresses with anti-inflammatory ointments (Indomethacin, Butadiene, Ortofen ) can be applied to the thyroid gland. At night, a thin layer of ointment is applied, the neck is wrapped with polyethylene, cotton and a scarf on top. The first time the compress is left for 15 minutes. If there are no negative reactions, the next day leave up to 30 minutes. Gradually increase the exposure time to two hours each time. Course 10 procedures. Together with ointments, you can use Dimexide , which is diluted in equal amounts with hot water. It not only stops the inflammatory process, but also improves the penetration of ointments into the deeper layers.

If signs of hyperthyroidism are not observed, as well as when neoplasms of a benign nature are detected in the thyroid gland, a month after the start of glucocorticosteroid therapy, thyroid drugs are prescribed: Thyreotom , L-thyroxine. These medicines are prescribed to eliminate seals in the gland. The duration of their treatment is 1.5 months. They must be taken constantly if the course of the disease is accompanied by hypothyroidism.

If subacute thyroiditis is prolonged and constantly worsens, then the doctor may prescribe immunomodulators of synthetic and herbal origin, for example, Timalin, Eleutherococcus tincture.

If subacute thyroiditis is accompanied by an anaerobic infection, Trichopolum is prescribed. This drug prevents the development of relapses of the disease.

To eliminate tachycardia, β-blockers are prescribed, for example, anaprilin .

Surgical treatment of subacute thyroiditis is carried out if symptoms such as:

• stricture of the esophagus and respiratory tract;
• an increase in the thyroid gland 3-4 degrees;
• large neoplasms of a benign nature;
• progressive enlargement of the thyroid gland against the background of conservative treatment;
• malignant tumors;
• cosmetic defect of the neck caused by the growth of the organ.

During the operation, the entire thyroid gland is usually removed at a time, but if it is left, then a relapse of the pathology is possible. After its removal, hypothyroidism develops, in which life-long hormone therapy is prescribed.

After consulting with a specialist, you can apply traditional medicine recipes.

With subacute thyroiditis, you can use a tincture of pine buds. To do this, they need to be crushed, fill them with a 0.5 liter jar to half and pour 0.5 liters of vodka. Infuse for a week in a dark, cool place. Make compresses with them 3 times a day.

Complications

If the disease is started, then the thyroid parenchyma will be completely damaged, as a result, it will not be able to function normally and produce the required amount of hormones. It is no longer possible to restore the organ, and you will have to take pills for the rest of your life.

Prevention measures

To prevent the development of subacute thyroiditis, you need to follow a number of rules:

• do not overcool;
• increase immunity by hardening and taking vitamin-mineral complexes;
• timely treat caries and diseases of the upper respiratory tract.

If you do not start the disease and start treatment on time, then recovery is possible in 2-3 months, otherwise you can completely lose the thyroid gland.