A Clinical Study and Short Term Outcome of the Patients Presented with Thyroiditis

Abed Hussain Khan,Aparna Das,Ashfaque Ahmed Siddique,Gobinda Banik,H A M Najmul Ahasan,Md Nahiduzzamane Shazzad,Mohammad Ashik Imran Khan,Mostofa Kamal Chowdhury,Rafia Afrose

doi:10.3329/jom.v14i1.14532

Abstract

Background: Thyroiditis-inflammation of thyroid gland includes a group of individual disorders having many different clinical presentations, aetiopathogenesis and histology. Sometimes they are overlapping on their presentations. Objectives: To see the clinical biochemical profile and to observe a short term outcome of the patients presented with different types of thyroiditis. Materials & methods: 50 cases with clinical suspicion of thyroiditis were randomly selected. Clinical history, Physical examination and serum T3, T4, TSH was done in every patient and FNAC of thyroid gland & TMab (Thyroid microsomal antibody) was estimated in some. They were followed up at three monthly intervals with the measurement of TSH. Results: Cases were subdivided in to 3 groups. Among them subacute thyroiditis were 19 (38%), 26 (52%) were Hashimotos thyroiditis and 5(10%) were silent thyroiditis. The subacute group presented with features of hyperthyroidism, negligible RAIU (radioactive iodine uptake) and FNAC ( Fine Needle Aspiration Cytology) showed granulomatous thyroiditis. During follow up (57%) became hypothyroid at 3 months, (26%) euthyroid and (15%) in thyrotoxic state. After 9 months (87%) was hypothyroid and (5.26%) thyrotoxic. At 12 months (94%) was euthyroid and one thyrotoxic. Hashimotos group presented in hypothyroid state, RAIU test were variable. FNAC showed lymphocytic infiltration in all patients. They were found 100% hypothyroid after 1 year. Silent Thyroiditis group were in hyperthyroid state with negligible RAIU. After 12 month (60%) became euthyroid and (40%) remain hypothyroid. Conclusion: Thyroiditis has both thyrotoxic and hypothyroid phase but they are self limiting. So before giving specific therapy, thyroiditis must be excluded.DOI: http://dx.doi.org/10.3329/jom.v14i1.14532 J MEDICINE 2013; 14 : 23-27

Highlights

Thyroiditis refers to inflammation of thyroid gland
Materials & methods: This observational study was done on 50 cases with clinical suspicion of thyroiditis on the basis of painful thyroid gland, low RAIU test, patients with thyrotoxicosis or hypothyroidism and FNAC suggestive of thyroiditis
Comprehensive clinical history, physical examination and routine serum T3, T4, TSH and RAIU test were done in every patient and FNAC of thyroid gland & TMab was estimated in some

Summary

Introduction

Thyroiditis refers to inflammation of thyroid gland. This includes rare acute bacterial infection to rarest Riddles thyroiditis. The relatively common forms are sub acute or De Quervain’s Hashimoto’s, silent, postpartum and drug induced thyroiditis like amiodarone, interferon.[1,2] All types of thyroiditis affect women more frequently than men and 3rd to 5th decades are the commonest age range.[3,4,5,6,7,8] There are some geographical and seasonal preponderance .[8,9] No symptoms unique to thyroiditis. The clinical course depends on their types. If the thyroiditis causes slow and chronic destruction, this would be a case of Hashimoto’s thyroiditis.[2]

Objectives

Methods

Results

Discussion

Conclusion