Diagnosis and management of thyroiditis.

Abstract

• In 1,309 operations on the thyroid gland, various forms of thyroiditis were encountered in 117 patients, excluding 83 other patients in whom a focal thyroiditis was associated with diffuse toxic and adenomatous goiter and carcinoma. Among the 117 patients there were 28 with acute and 89 with chronic thyroiditis. The acute thyroiditis led to suppuration in 6 patients; they required surgical incision and drainage, and all recovered with the aid of antibiotics, chemotherapy, and supportive measures. There were 22 patients in whom the acute thyroiditis did not go on to suppuration; antibiotic and x-ray therapy sufficed in 8 of these, but surgery was necessary in 14. The 89 patients with chronic thyroiditis were classified, upon examination of tissues removed at operation, as having Hashimoto's disease in 67, giant cell thyroiditis (granulomatous thyroiditis) in 16, and Riedel's struma in 6 cases. Surgical treatment of these forms of chronic thyroiditis is necessary in order to restore a normal appearance to the neck, to relieve pressure especially on the trachea, and to obtain adequate tissue specimens for diagnosis. Aspiration biopsies have not always yielded adequate specimens, and radiation therapy given in quantities sufficient to reduce the size of the thyroid also reduces its function. In this series of cases there were neither operative deaths nor serious postoperative complications.