Thyroid and Parathyroid

thyroid cancer (other than lymphoma) is found. Thyroxine therapy with long-term
. follow-up monitoring of TSH levels is recommended
( Subacute Thyroiditis (De Quervain's Thyroiditis
Subacute thyroiditis, also known as de Quervain's, granulomatous, or giant cell
thyroiditis, is an uncommon, acute inflammatory disease of the thyroid. It is thought
to be precipitated by a viral infection, although the exact cause is unknown. It is
commonly encountered in North America but is relatively rare in the United Kingdom
and Europe. The disease may be responsible for up to 10 percent of patients with
hyperthyroidism in the United States. It affects women five times more often and
. usually is seen in patients 20 to 40 years of age
Clinical Manifestations
Patients usually present with fever, malaise, and unilateral or bilateral thyroid pain
and a recent history of an upper respiratory tract or viral infection may be given.
Some patients complain of the symptoms of thyrotoxicosis, including palpitations,
sweating, and heat intolerance, which are caused by the release of thyroid hormones
from disrupted follicles in the inflamed thyroid gland. Palpation of the thyroid gland
. may reveal a tender, firm gland with mild unilateral or bilateral enlargement
Pathology and Diagnostic Tests
Histologically, the disease is characterized by an acute inflammatory reaction of the
thyroid gland. Degenerative thyroid follicles are surrounded by giant cells forming
granulomas, which may be demonstrated on FNAC. Laboratory investigations
demonstrate an elevated erythrocyte sedimentation rate (ESR) associated with a
neutrophilia. Thyroid function tests usually show elevated levels of thyroid hormones
(T4 and T3) with suppression of TSH. As the disease resolves, thyroid hormone levels
return to normal, although the TSH level can remain low for some time. In contrast to
Graves' disease, radioiodine uptake in the acute stage of the disease is low or
negligible, because the released thyroid hormone, as result of inflammation,
. suppresses the serum TSH concentration
Treatment
Usually treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief
is all that is necessary. Treatment with NSAIDs should be continued for several weeks
after the disease has resolved in an effort to prevent recurrence. Beta blockers (e.g.,
propranolol) in the initial stages of the disease can be useful for relief of thyrotoxic
symptoms. In the more severe cases it might be necessary to prescribe steroids for
short periods. Prednisolone 40 mg once daily for 1 to 2 weeks, followed by a gradual
. reduction of the dose over the ensuing month, is recommended in such cases
The disease usually lasts 1 to 6 weeks and resolves spontaneously. In some cases the
disease lasts from several weeks or months and runs a course alternating between
bouts of exacerbation followed by periods of remission. Most patients have complete
resolution of the disease, although 10 percent of patients experience permanent
. hypothyroidism and require thyroxine replacement therapy
Riedel's Thyroiditis
Riedel's thyroiditis is a rare disease of the thyroid characterized by a marked dense,
invasive fibrosis that may extend beyond the thyroid capsule and involve surrounding