5 Questions
What is the purpose of checking blood levels of thyroid hormone at periodic intervals?
To ensure the correct dose of Levothyroxine medication
What is the primary treatment for managing hypothyroidism caused by chronic lymphocytic thyroiditis?
Levothyroxine
What is the significance of thyroid peroxidase (TPO) in the diagnosis of chronic lymphocytic thyroiditis?
It indicates that the immune system is attacking the thyroid
Why may ultrasound or other medical imaging tests be ordered in patients with chronic lymphocytic thyroiditis?
To evaluate the size of the goiter and determine if treatment such as surgery may be warranted
What is the result of untreated chronic lymphocytic thyroiditis?
Chronic hypothyroidism
Study Notes
Riedel Thyroiditis
- Presents as hypothyroidism with a "stone-like, hard-as-wood" nontender thyroid gland
- Diagnostic criteria:
- Extra-thyroidal extension of the inflammatory process
- Presence of occlusive phlebitis
- Absence of granulomas, giant cells, lymphoid follicles, or oncocytes
- Absence of thyroid malignancy
- Causes:
- Intense fibrosis of the thyroid and surrounding structures (including mediastinal and retroperitoneal fibrosis)
- Treatment:
- Symptomatic with propranolol
- Glucocorticoids as the mainstay of medical treatment
- Tamoxifen as a selective estrogen receptor modulator (SERM)
- Mycophenolate mofetil as an immunosuppressive agent with antifibrotic properties
Thyroid Disease Approach
- Evaluation of a thyroid nodule:
- Initial step: TSH level (most sensitive test) for the diagnosis of suspected hyperthyroidism
Graves Ophthalmopathy
- Initial therapy: Steroids
- Radiation therapy for those not responding to steroids
- Severe cases may require decompressive surgery
Symptoms
- Thyroid enlargement without pain or tenderness
- Early symptoms of hyperthyroidism:
- Heart palpitations
- Nervousness
- Weight loss
- Heat intolerance
- Diarrhea
- Increased appetite
- Late symptoms of hypothyroidism:
- Cold intolerance
- Weight gain
- Constipation
- Fatigue
Prognosis
- Subacute thyroiditis: may recur every couple of years in some individuals
- Chronic lymphocytic thyroiditis: a lifelong condition
- With appropriate treatment, thyroid levels can return to normal, and symptoms may completely subside
Chronic Lymphocytic Thyroiditis
- Symptoms:
- Fatigue
- Weight gain
- Cold intolerance
- Loss of appetite
- Constipation
- Depression
- Joint stiffness
- Muscle pain
- Miscarriage
- Changes in the menstrual cycle
- Dry skin
- Hair loss
- Slow heart rate
- Difficulty concentrating
- Poor memory
- Reduced exercise tolerance
- Goiter (enlarged thyroid)
- Diagnosis:
- Physical exam including palpating the thyroid for enlargement or goiter
- Blood tests: thyroid hormone levels (T3, T4, TSH) and thyroid peroxidase (TPO) level
- Ultrasound or medical imaging may be ordered to evaluate the size of the goiter and determine if treatment such as surgery is warranted
- Treatment: Levothyroxine is the treatment of choice for managing hypothyroidism due to chronic lymphocytic thyroiditis.
Test your knowledge about Riedel thyroiditis, a rare condition that presents as hypothyroidism with a unique set of symptoms and characteristics. Learn about the diagnostic criteria, causes, and effects of this condition. Evaluate your understanding of this topic with this quiz!
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