Thyroiditis, a feminine affliction

Located in the front of the neck, regulating body metabolism, the thyroid gland (an endocrine gland) produces two main hormones: thyroxine or triiodothyronine (T4) and tri-iodo-thyronine (T3), hormones transported in the human body through the bloodstream and lymphatic system that enable the cells of the body and therefore the organs to function and to ensure their vital functions. (Growth, neural development …) Therefore, an increase or decrease in the production of these hormones has an effect on a particular organ and thus on the patient’s general health as well as on the way the gland reacts when it is confronted with a situation that forces it to modify the operation of a particular organ of the human body (increased heart rate, increased body heat, increased thirst …). This gland can be disrupted in its primary function by a disease that affects it directly. The importance of the thyroid gland is such that children with a dysfunction (poor thyroid hormone synthesis) or malformation of the thyroid often have delays in their growth and even serious intellectual challenges. Please note that these hormones are made from iodine that is found in its natural state in many foods, hence the importance of a balanced diet rich in iodine (shellfish, dairy products, eggs, sardines …)

Thyroiditis, what is it?

Especially affecting women, thyroiditis is an inflammation of the thyroid gland. Thus, a thyroid disorder disturbs the ‘message’ chemically sent to organs through these thyroid hormones. There are several types of thyroiditis, autoimmune thyroiditis thyroid cells are attacked and destroyed by the body itself through antibody and non-autoimmune thyroiditis (from an external factor)

The different types of thyroiditis, causes and symptoms

The autoimmune thyroiditis

There are several types of autoimmune thyroiditis:

• Chronic lymphocytic thyroiditis (or Hashimoto’s thyroiditis) This is the most common form of thyroiditis in its chronic form. Often devoid of symptoms, it is however characterized by the presence of a fairly discrete goiter, i.e. an increase of the thyroid volume that takes the form of a hard mass in the neck. Hyperthyroidism and hypothyroidism can occur; the increase and decrease in thyroid hormone production creating an acceleration (hyperthyroidism) and a slowdown of the metabolism (hypothyroidism). Eventually the thyroid is destroyed by the patient’s own antibodies directed against the glandular tissue.
• Riedel’s thyroiditis or woody thyroiditis; rare and severe thyroid disease in an advanced stage. It causes inflammation and fibrosis of the gland (which loses its flexibility) to the point where the trachea can be compressed as a result of the hardening of the entire mediastinum (area between the two lungs) which then leads to impaired breathing (dyspnea), impaired swallowing (dysphagia), but also to speech impairment. The evolution results in the destruction of the thyroid.
• Painless thyroiditis (also called silent) and postpartum thyroiditis, both often observed following pregnancy. Both diseases have all the characteristics of Hashimoto’s thyroiditis.

Non autoimmune thyroiditis

There are several types of thyroiditis, often of viral origin:

• Subacute thyroiditis or De Quervain Benign thyroiditis and of viral origin, it occurs particularly following an ENT disease (flu, sore throat, mumps …) It is accompanied by severe pain radiating to the jaw and ears and from the base of the neck, with mild hyperthyroidism and hypothyroidism, muscle aches, fever, general fatigue, a slight but painful goiter, a rapid heartbeat and related symptoms such as dysphagia.
• Acute thyroiditis of bacterial origin or due to fungi is accompanied by pain localized to the thyroid which will tend to become hard; fever, skin lesions, swelling of the lymph nodes and abscesses.
• The parasitic thyroiditis (also called Chagas disease) whose origin is a parasite, the trypanosome.

The most common symptoms

The most common symptoms and which have to be taken into consideration are:

• An increase of the thyroid volume which leads to the formation of a characteristic goiter
• Difficulty while breathing and eating

Thyroiditis can cause hyperthyroidism, namely an increase of the production of thyroid hormone; symptoms are:

• Digestive disorders (diarrhea …)
• Rapid weight loss
• Abnormal sweating
• Excessive thirst
• Fatigue
• A sensation of warmth
• Loss of libido
• Increased heart rate (tachycardia)
• Hot and clammy skin
• Brittle hair
• Irregular menstruation
• Sleep disorders
• changing mood

or it can cause hypothyroidism, namely a decrease in production of thyroid hormones; the symptoms are:

• Weight gain
• A decrease in heart rate (bradycardia)
• Dry skin that tends to thicken
• Constipation
• Severe fatigue
• Brittle nails
• Disruption or even cessation of menstruation
• Chills, a sensation of cold
• Joint pain, cramps
• Decreased appetite

Diagnosis and treatment of thyroiditis

Diagnosis

The doctor will initially palpate the thyroid in the neck to see if there is an inflammation or not. To confirm thyroiditis,

• An ultrasound scan of the thyroid will be performed
• A scintigraphy can be used
• A biopsy can be performed
• A blood test in the laboratory of TSH or thyroid stimulating hormone indicator of the hyperfunction or hypofunction of the thyroid.
• And more particularly in the case of:
  • De Quervain’s thyroiditis, a blood test will be performed to:
    • target the sedimentation rate that has the characteristic of being high in cases of thyroid inflammation.
    • reveal a low TSH
    • reveal high hormones T3 and T4
  • Hashimoto’s thyroiditis, a thyroid blood test will be performed to:
    • look for the presence of high levels of anti-TPO antibodies
    • look for the presence of anti-TG antibody
    • observe a low T3 and T4
    • reveal a high TSH
    • reveal high levels of gamma globulin
  • Riedel thyroiditis, the following tests will be performed:
    • a Doppler ultrasound to rule out other pathology (cancer)
    • a dosage of thyroid hormone levels generally lower than normal
    • search for nonexistent thyroid antibodies in the case of this disease

Treatment

• The doctor will prescribe antibiotics in case of viral, bacterial thyroiditis. (Acute thyroiditis)
• In case of Hashimoto’s thyroiditis, thyroid hormones and cortisone will be prescribed. Consulting a surgeon is recommended if the goiter is large.
• In case of De Quervain’s thyroiditis, non-steroidal anti-inflammatory drugs will be prescribed for the inflammation to disappear within weeks.
• In case of Riedel thyroiditis, surgery will be necessary to end the compression.