ABSTRACT
El término tiroiditis comprende un grupo de enfermedades de la glándula tiroides caracterizado por la presencia de inflamación, abarcando entidades autoinmunes y no-autoinmunes. Pueden manifestarse como enfermedades agudas con dolor tiroideo severo (tiroiditis subaguda y tiroiditis infecciosas), y condiciones en las cuales la inflamación no es clínicamente evidente, cursando sin dolor y presentando disfunción tiroidea y/o bocio (tiroiditis inducida por fármacos y tiroiditis de Riedel). El objetivo de esta revisión es aportar un enfoque actualizado sobre las tiroiditis no-autoinmunes cubriendo sus aspectos clínicos, diagnósticos y terapéuticos.
The term thyroiditis comprises a group of thyroid diseases characterized by the presence of inflammation, including autoimmune and non-autoimmune entities. It may manifest as an acute illness with severe thyroid pain (subacute thyroiditis and infectious thyroiditis), and conditions in which the inflammation is not clinically evident evolving without pain and presenting primarily thyroid dysfunction and/or goiter (drug-induced thyroiditis and Riedel thyroiditis). The aim of this review is to provide an updated approach on non-autoimmune thyroiditis and its clinical, diagnostic and therapeutic aspects.
Subject(s)
Humans , Thyroiditis/diagnosis , Thyroiditis/etiology , Thyroiditis/therapy , Thyroiditis, Subacute/diagnosis , Thyroiditis, Suppurative/diagnosis , Thyroiditis, Suppurative/etiology , Thyroiditis, Suppurative/therapy , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Chronic Disease , Interferon-alpha/adverse effects , Lithium Compounds/adverse effects , Diagnosis, Differential , Glucocorticoids/therapeutic use , Goiter/complications , Amiodarone/adverse effectsABSTRACT
A tireotoxicose é um estado hipermetabólico decorrente dos efeitos de níveis teciduais elevados de hormônios tireoideanos (HTs). O hipertireoidismo é a causa mais comum, e decorre do excesso de hormônios produzidos pela tireoide. Outras causas de tireotoxicose ocorrem por produção extratireoideana ou administração exógena de hormônios tireoideanos. A principal causa de tireotoxicose, o bócio difuso tóxico (BDT) de causa autoimune, responsável por até 80% dos casos, é aqui abordado, assim como as demais causas. O tratamento é realizado com drogas antitireoideanas, iodo radioativo ou cirurgia e exige acompanhamento de longo prazo, tanto pela possibilidade de recidivas como do desenvolvimento de hipotireoidismo.
Thyrotoxicosis is a hypermetabolic state due to the effects of high tissue levels of thyroid hormones (TH). Hyperthyroidism is the most common cause and results from excess hormones produced by the thyroid. Other causes of thyrotoxicosis occur extra thyroid production or exogenous administration of thyroid hormones. The main cause of thyrotoxicosis, the diffuse toxic goiter (DTG) of autoimmune cause, accounting for up to 80% of cases, is discussed here, as well as other causes. The treatment is performed with antithyroid drugs, radioactive iodine or surgery and requires long-term follow-up, due to both the possibility of recurrence and the development of hypothyroidism.
Subject(s)
Humans , Male , Female , Goiter/surgery , Goiter/therapy , Hyperthyroidism/diagnosis , Hyperthyroidism/etiology , Hyperthyroidism , Antithyroid Agents/therapeutic use , Thyroid Gland/surgery , Thyroid Hormones/metabolism , Eye Diseases/complications , Iodine Radioisotopes/therapeutic use , Thyrotoxicosis , Thyroiditis/etiologySubject(s)
Humans , Male , Female , Thyroid Gland/pathology , Fibrosis/complications , Thyroiditis/classification , Thyroiditis/etiologyABSTRACT
La falla ovárica prematura (FOP), también llamada menopausia precoz, se define como la pérdida de la función cíclica de los ovarios antes de los 40 años de edad y después de la pubertad. Se ha reportado anormalidades endocrinas y autoinmunes asociadas con la FOP y se ha sugerido que las enfermedades tiroideas son comunes. Sesenta y dos mujeres con FOP fueron estudiadas para determinar la frecuencia de trastornos tiroideos, ya que no hay estudios sobre esta asociación en esta región geográfica. La evaluación incluyó historia clínica y examen físico, medición de tiroestimulina (TSH)...
Subject(s)
Female , Goiter/diagnosis , Goiter/physiopathology , Hypothyroidism/prevention & control , Menopause, Premature/physiology , Thyroiditis/etiologyABSTRACT
Isolated involvement of the thyroid by tuberculosis is very rare as reported in literature. We are presenting a case of isolated tuberculous thyroiditis presented as a solitary thyroid nodule. The patient was treated with anti-tuberculous regimen and he responded well with disappearance of the nodule and normalization of the thyroid scan
Subject(s)
Humans , Male , Tuberculosis , Thyroid Nodule/etiology , Thyroiditis/etiology , Antitubercular Agents , Rifampin , PyrazinamideABSTRACT
El espectro clinicopatológico de las tiroiditis abarca, desde la rara tiroiditis aguda o supurativa hasta la más rara tiroiditis de Riedel. Las tiroiditis subaguda y silente (y su variante postpartum) también son enfermedades no comunes, mientras que la tiroiditis crónica autoinmune o enfermedad de Hashimoto resulta la tiroiditis y la enfermedad autoinmune órgano específica más frecuente, responsable de la mayor parte de los casos de hipotiroidismo. Efectivamente, en las áreas geográficas no deficientes en yodo, la mayor parte de los desórdenes tiroideos se deben a enfermedad autoinmune. La autoinmunidad como fenómeno primario juega un papel trascendente en la etiopatogenia de la tiroiditis crónica autoinmune, la tiroiditis silente-postpartum y la tiroiditis de Riedel y, sólo un rol secundario en la tiroiditis subaguda. Posiblemente, las infecciones virales causan la tiroiditis subaguda, mientras que los gérmenes piógenos y hongos son responsables de la tiroiditis supurativa. Las tiroiditis autoinmunes y la tiroiditis subaguda se acompañan comúnmente de disfunción tiroidea. Se conoce como tiroiditis destructiva al proceso inflamatorio tiroideo acompañado de destrucción y tirotoxicosis transitoria.
En estos casos, la disfunción tiroidea adopta usualmente el patrón de tiroiditis bifásica, en la que secuencialmente, la tirotoxicosis pasajera va seguida de hipotiroidismo transitorio y recuperación. Desórdenes con diferente etiopatogenia, como la tiroiditis subaguda, la tiroiditis silente y la enfermedad de Hashimoto, son responsables de los fenómenos fisiopatológicos similares que dan origen a la tiroiditis bifásica. El dolor en la tiroides adquiere relevancia en la tiroiditis subaguda y en la tiroiditis supurativa y, sólo raramente, está presente en la tiroiditis silente o en la exacerbación aguda de la enfermedad de Hashimoto. En la mayor parte de los casos, es posible establecer el diagnóstico de la tiroiditis mediante la historia clínica, las pruebas de función tiroidea y los estudios isotópicos y ecosonográficos. La biopsia tiroidea por aspiración con aguja fina permite resolver los casos dudosos. Esta revisión del Espectro clínico-patológico de las tiroiditis, resulta una síntesis de la información bibliográfica y la experiencia lograda con las tiroiditis a través de un enfoque clínico integral.
Clinical-pathological spectrum of thyroiditis comprises from the rare acute o suppurative thyroiditis as far as the rarest Rieldels thyroiditis. Also, subacute and silent thyroiditis (and it postpartum variant) are non common diseases, while autoimmune chronic thyroiditis or Hashimotos disease results the most frequent thyroiditis and organ-specific autoimmune disorder, that is responsible for most part of hypothyroidism cases. Effectively, in iodine-replete geographic areas, most persons with thyroid disorders have autoimmune disease. Autoimmunity as primary phenomenon plays a transcendent role in etiopathogeny of chronic autoimmune thyroiditis, silent-postpartum thyroiditis and Riedels thyroiditis and only a secondary role in subacute thyroiditis. Probably, viral infections cause subacute thyroiditis, while pyogenic germs and fungus are responsible for suppurative thyroiditis. Commonly, autoimmune and subacute thyroiditis are associated with thyroid dysfunction. It is known as destructive thyroiditis, the thyroidal inflammatory process that is joined to destruction and transient thyrotoxicosis.
Usually, thyroid dysfunction in these cases adopt biphasic thyroiditis pattern, in which sequentially, transient thyrotoxicosis is followed by transient hypothyroidism and recovery. Disorders with different etiopathogeny as subacute thyroiditis, silent thyroiditis and Hashimotos thyroiditis are responsible of similarly physiopathologic phenomenons that originated biphasic thyroiditis. Pain in the thyroidal gland is relevant in subacute and suppurative thyroiditis and, rarely is present in silent thyroiditis or in acute exacerbation of Hashimotos thyroiditis. In most of the cases, it is possible to establish the diagnosis of thyroiditis through clinical history, thyroidal function tests, isotopic studies and ecosonography. Thyroid fine needle biopsy resolves doubtful cases. This review about Clinical-pathological spectrum of thyroiditis, results from the synthesis of bibliographic information and the experience obtained with thyroiditis through and integral clinic focus.
Subject(s)
Humans , Fungi/immunology , Inflammation/pathology , Thyroiditis/classification , Thyroiditis/etiology , Thyroiditis/pathology , Thyrotoxicosis/pathology , Biopsy/methods , Hashimoto Disease/pathologyABSTRACT
We describe a dialysis patient who acquired acute Hepatitis C infection. Her primary renal disease was systemic lupus erythromatosis. She was having goitre but clinically euthyroid and her thyroid function test was normal. To avoid long term complications of Hepatitis C we elected to treat her with Interferon 3 million units subcutaneously 3 times a week. During treatment she developed some transient side effects initially which subsided but later she felt pressure symptoms around her neck. When we checked her TSH and thyroid antibodies these were elevated. Though this could be related to HCV, rarely, but we think the thyroid change is mostly related to Interferon. Some possible explanation of the effect of Interferon on thyroid have been reviewed and we think patients getting such drugs should be under close monitoring to avoid permanent thyroid dysfunction
Subject(s)
Humans , Female , Kidney Failure, Chronic/therapy , Renal Dialysis/adverse effects , Interferons , Interferons/adverse effects , Thyroiditis/etiology , Thyroiditis, Autoimmune/chemically induced , Hepatitis CABSTRACT
Two cases of tuberculosis of the thyroid gland which presented as solitary nodules are reported. History in both the cases was suggestive of tuberculosis, which was confirmed on the histopathology of resected tissue. Treatment by resection and antituberculous drugs gave satisfactory results
Subject(s)
Humans , Female , Thyroid Diseases/diagnosis , Tuberculosis/diagnosis , Thyroid Nodule/diagnosis , Thyroiditis/etiologyABSTRACT
Apresenta-se um caso de tireoidite aguda supurativa em um menino de nove anos de idade que havia apresentado um episódio anterior sete meses antes. A causa desta afecçäo foi uma fístula do seio piniforme que foi fechada cirurgicamente. A cultura do tecido tireoidiano revelou a presença de Streptococcus viridans
Subject(s)
Child , Humans , Male , Fistula/complications , Thyroiditis/etiology , Suppuration , Thyroid Gland/pathologyABSTRACT
Tuberculosis of thyroid gland is a rare disease, the diagnosis of which is based on bacteriological and/or histological criteria and on the notion of an isolated thyroid infection. Bringing 2 observations, the authors recall the thyroid gland's resistance to infection generally, and tuberculosis in particular; the different clinical pictures and imperatives of treatment being no different from the other localizations of tuberculosis. This treatment enables a simplification of the evolution of the disease and a preservation of the thyroid function