Thyroiditis is a disease of the thyroid gland, which includes a number of pathological processes that occur with the development of inflammation in this organ. This thyroid pathology refers to conditions that have different etiology and different pathogenesis.  

According to its development and features of the clinical course, the disease can develop as:

• acute thyroiditis – has a purulent or non-purulent character, may be accompanied by the development of local or disseminated lesions in the organ;
• subacute thyroiditis – manifested by diffuse or focal damage to the thyroid gland, which develops gradually;
• chronic thyroiditis is a condition caused by autoimmune disorders or specific pathogens that take part in the development of this form of the disease (tuberculous, syphilitic, septicomycotic type of thyroiditis). The disease often occurs after childbirth or during periods of hormonal changes in the body (puberty, menopause) and is characterized by the presence of diffuse lesions of the glandular tissue of the thyroid gland. 

REASONS OF THYROIDITIS

The inflammatory process in the thyroid gland develops under the influence of various pathogenic (disease-causing) factors, among which are:

• injury to the thyroid gland and hemorrhages in this gland, regardless of the cause of their occurrence;
• performing radiation therapy or exposure to ionizing radiation as a result of professional activities;
• viral infection, especially influenza, measles, or mumps (mumps) viruses;
• destruction of follicles, as well as follicular cells of the gland (autoimmune thyroiditis of the thyroid gland) – the disease develops under the influence of antibodies that are different in structure, including autoimmune, produced against viral, 
• bacterial pathogens;
• chronic autoimmune thyroiditis ( lymphocytic form or Hashimoto ‘s thyroiditis ) – occurs with autoimmune changes in the body, which are accompanied by the destruction of the gland parenchyma by progressive lymphoid infiltration. 

CLINICAL PICTURE OF THYREOIDITIS

In cases where a patient develops thyroiditis, the symptoms depend on the type of disease. Its acute purulent form is manifested by pain in the neck, which radiates to the lower jaw and the back of the head, becomes more intense when moving the head or when swallowing. Regional lymph nodes are enlarged. Chills and high fever are noted, a pronounced violation of the general condition, which forces the patient to seek medical help without delay.

The acute non-suppurative form of the disease is characterized by less pronounced clinical symptoms. At the beginning of the development of thyroiditis, signs of thyrotoxicosis may be observed. Patients complain of increased sweating, hand tremors, palpitations and noticeable weight loss. The examination reveals an increased level of thyroid hormones with a normal level of thyroid-stimulating hormone of the pituitary gland. 

With a long course, the signs of thyrotoxicosis are replaced by the clinical picture of hypothyroidism – there is a gradual replacement of the destroyed cells of the glandular part of the organ with connective tissue – inflammation is replaced by fibrosis. Patients become lethargic and drowsy. Chilliness appears, the face swells, the skin becomes dry. The heart rate decreases and constipation occurs. A blood test reveals a low level of thyroid hormones, increases the concentration of thyroid-stimulating hormone, and changes the profile of sex hormones. The gland itself is often enlarged and painful on palpation.

When patients have autoimmune thyroiditis, the symptoms of this pathology may not appear for several years . Over time, the enlarged thyroid gland compresses the surrounding tissues, causing the corresponding symptoms – complaints occur, characteristic of a mass in the neck. In addition, the functioning of the gland is disrupted – the concentration of thyroxine, triiodothyronine, TSH changes. First, hyperthyroidism occurs, later in the clinical picture, signs of hypothyroidism prevail. When this form of the disease is detected, an important diagnostic criterion is a high titer of antibodies to thyroid cells.  

The possibility of the development of signs of autoimmune thyroiditis in patients with diffuse connective tissue diseases – rheumatoid arthritis (rare), systemic lupus erythematosus or systemic scleroderma (very common) cannot be ruled out . With the appointment of appropriate immunosuppressive therapy, the symptoms of thyroiditis gradually undergo a reverse development. 

TREATMENT OF THYROIDITIS

The principles of therapeutic measures depend on the nature of the pathological process developing in the thyroid gland.

WITH SUBCURRENT THYROIDITIS

Thus, if subacute thyroiditis is present, treatment should include corticosteroids such as prednisolone or dexamethasone. Salicylic agents or non-steroidal anti-inflammatory drugs are also prescribed. If the clinical picture shows signs of hypothyroidism, small amounts of thyroid hormones are prescribed – the duration of the course of treatment depends on the severity of the patient’s condition and the response of his body to the prescribed therapy. It should be remembered that all therapeutic measures should be carried out under the supervision of a physician and appropriate laboratory control. 

IN THE ACUTE PHASE

In acute thyroiditis, active antibiotic therapy is performed , symptomatic agents and vitamins are prescribed. When choosing a drug, preference should be given to antibiotics of a wide spectrum of action, but they should be prescribed taking into account the possible allergy in the patient, and the possible pathogen. If specific antibodies are found in the blood (to the causative agents of syphilis, tuberculosis), it is necessary to prescribe standard therapy for these diseases. 

IN CASE OF CHRONIC DISEASE

If chronic autoimmune thyroiditis develops, treatment includes taking thyroid hormones (thyroxine, triiodothyronine), as well as GCS. If the enlarged thyroid gland significantly compresses the organs of the neck, surgery is performed – in the vast majority of cases, a partial organ resection is performed.

The inflammatory process in the tissue of the thyroid gland (thyroiditis) is currently a fairly common disease, for the treatment of which it is necessary to take into account the cause of the development of the pathological process, the clinical picture and data of additional examination, as well as the presence of concomitant diseases in the patient .