Thyroiditis is a large category of neoplasms in the thyroid gland, accompanied by inflammatory processes. The most particular type of thyroiditis is the chronic course. In most manifestations with the progression of the disease, the functional capacity of the organ decreases, which leads to the appearance of hypothyroidism requiring treatment with hormonal drugs.
Causes of thyroiditis.
Chronic thyroiditis occurs with an autoimmune lesion of the organ. In this case, antibodies to different components of the gland appear, which is not characteristic of a healthy organism. Autoimmune thyroiditis is the most frequent inflammatory process in the thyroid gland. As a rule, this disease is found in people aged 40-50 years. Moreover, women suffer from this disease more often than men. In our time, thyroiditis is increasingly occurring in people younger than 40 years.
The causes of the chronic disease have not yet been established. Many doctors believe that inflammatory processes in the thyroid gland occur in all forms of endemic goiter.
Classification of the forms of the disease.
In medicine, the classification of thyroiditis is based on the clinical manifestation of the disease and its flow characteristics. There are three main forms of the disease:
The protracted course of thyroiditis includes the following types of diseases: autoimmune thyroiditis, specific thyroiditis with syphilitic, tuberculous and septomycotic type of etiology, invasive-fibrotic goiter.
The acute course of the disease can affect both one part of the organ and the entire thyroid gland. In addition, an inflamed focus can occur in a small part of the gland. The inflammation itself can be with the absence of purulent formation and with its presence. The second type of thyroiditis occurs extremely rarely.
Subacute form of the disease occurs in the following types of course: pneumocystic, granulomatous and lymphatic thyroiditis. Situated such a disease can be local or in the whole body.
Chronic fibrous thyroiditis for a long time does not reveal itself as any symptoms and disturbances of general well-being. At the initial stage, the disease manifests itself through a feeling of difficulty swallowing food. At later stages, there is a violation of the swallowing function, breathing, speech, hoarseness appears in the voice. When palpation, the doctor discovers uneven swelling of the gland in the form of tubercles of dense structure. The tumor is immobile and painful. As a rule, the thyroid gland is affected by a diffuse tumor, which leads to a decrease in functionality and the appearance of hypothyroidism. Patients usually suffer from headaches, decreased visual acuity, complain of tinnitus, problems with eating and with inspiration / expiration. All these symptoms are a consequence of the compression syndrome.
A group of specific thyroiditis consists of diseases characterized by structural and inflammatory changes in the tissues of the thyroid gland with its syphilitic, tuberculous and mycotic lesions. These types of diseases are characterized by a chronic course. If any secondary infection is added to the disease, the thyroiditis can go to the acute stage.
The acute form of the course of thyroiditis can be characterized by:
Presence of purulent formation;
Absence of abscesses.
When a purulent acute thyroiditis occurs, infiltration of the thyroid gland is revealed, accompanied by an inflammatory process and passing into an abscess. The suppressed part of the gland ceases to function normally, and does not interfere with the production of hormones by a healthy part of the organ.
Purulent disease progresses into acute form and has such symptoms as a significant increase in body temperature, a feeling of fever. Many patients complain of severe and cutting pain in the neck area in front. Pain can respond in the occipital part of the head, tongue, jaw, ears. Painful sensations become stronger with ingestion of food, turning the head to the sides or moving up / down, as well as when coughing and sneezing. The poisoning of the body quickly becomes significant and is manifested by a feeling of bad mood, general malaise, pulling and pounding pains in the joints and muscles, the appearance of tachycardia and headache. Quite a part of the medical staff assess the patient’s condition as extremely difficult.
During medical examination, a full or partial increase in the organ is detected, while palpation of the neck causes severe pain. The structure of the thyroid gland at the infiltrative stage of the inflammatory process is dense, and when abscesses and abscesses develop, it is mild. Most patients have blood filling of the skin of the neck (severe reddening), local temperature increase, pain syndrome in the lymph nodes of the cervical region.
In the non-swollen flow of the acute form of thyroiditis, there is aseptic inflammation of the affected part of the thyroid gland and has no strongly pronounced symptoms.
Subacute thyroiditis is characterized by pronounced inflammatory processes that manifest themselves by raising body temperature above 38 degrees, strong pain in the anterior part of the neck, which are deposited in the ears, the back of the head, and the jaw. In addition, patients often complain of general weakness in the body. The course of this form of the disease, as a rule, is gradual. The first symptoms are a feeling of malaise, moderate pain in palpation of the neck in front, a slight increase in thyroid gland, slight discomfort when moving head. Pain can become stronger when eating. When you feel the thyroid gland, its increase is noted, as well as the pain syndrome in one part of the organ. In this form of the disease, the lymph nodes can be of normal size.
Thyroiditis of subacute form in most patients is supplemented by the appearance of thyrotoxicosis in varying degrees of manifestation. Patients complain of heart rhythm inconsistency, sweating, general malaise, problems with falling asleep, joint pain and heat intolerance. Thyrotoxicosis can persist for 1-2 months. This period is characterized by pain in the thyroid gland and anterior part of the neck, a decrease in the degree of radioactive iodine in the body, thyrotoxicosis. In acute type of the disease there is a shortage of hormones.
During the growth of the tumor, the intake of hormones into the blood decreases, which leads to euthyroidism. In severe thyroiditis, there is an exhaustion of the thyroid hormones in the body. Subacute thyroiditis is completed by recovery and gradual return of the thyroid gland to normal functioning.
The acute form of thyroiditis can result in the appearance in the thyroid gland of a purulent formation that is capable of breaking through. It is dangerous for internal infection if a breakthrough occurs under the skin. Pus can get into the pericardial space. A large ulcerous tumor in the cervical region can cause damage to the vasculature, the introduction of a purulent infection into the brain tissue and even to blood infection. That is why to conduct therapeutic therapy for acute thyroiditis is necessary immediately after the appearance of the first symptoms, not launching the disease to a critical condition.
With subacute thyroiditis, complications can occur in the form of a significant lesion of thyroid tissue and the need for its complete removal. Such complications arise, as a rule, in those patients who do not receive timely medical care.
If you consult a doctor in a timely manner and receive proper treatment, then the acute form of thyroiditis is completely cured and, in the future, does not remind you of yourself as a patient.
Simple thyroiditis without complications is overwhelmingly cured in the vast majority of cases. However, after therapeutic therapy and recovery in the tissues of the thyroid gland, small nodular formations may remain. You do not need to treat them.
When diagnosing autoimmune thyroiditis, the predictions are much worse. Even with the timely detection and receipt of therapeutic therapy, most patients experience gradual extinction of the functionality of the thyroid gland, which leads to hypothyroidism. In turn, this requires the intake of hormonal drugs, usually for life.
What can a doctor do to determine thyroiditis?
The appointment of drug therapy for any course of thyroiditis should be performed by an endocrinologist.
Acute thyroiditis requires the intake of antibiotics, preparations with vitamin C and group B vitamins, as well as drugs that eliminate the symptomatic manifestation of the disease. If there is an abscess of acute purulent thyroiditis, then surgical intervention is inevitable to remove purulent accumulation. During the operation, the abscess is opened and all pus is removed from it. After that, the inflamed place is treated with an antibiotic and covered with a bandage.
Chronic fibrotic thyroiditis, accompanied by the appearance of hypothyroidism, requires the appointment of replacement therapy with synthetic thyroid hormone preparations. When a squeezing of the respiratory trachea is detected, the patient undergoes a surgical operation.
Subacute thyroiditis is treated with a prolonged intake of drugs of the category “corticosteroids”, drugs of the salicylic complex with a decrease in the dose of corticosteroid drugs. When hyperthyroidism is detected, medications are prescribed that can reduce the amount of thyroid hormones in the patient’s blood. When detecting hypothyroidism, drugs containing thyroid hormones are prescribed.
Chronic autoimmune thyroiditis requires the use of drugs with the content of thyroid hormones. If nodular goiter does not decrease with replacement therapy for 4 months, the doctor can prescribe strong hormonal drugs such as prednisolone, which must be taken at least 3 months. Only after this period can you reduce the daily dose and gradually completely abandon the drug. With a dynamically developing disease with painful manifestations and rapid growth of the tumor, immediate surgical intervention is required to cut off the diseased tissue of the thyroid gland.
What should the patient do?
When revealing the first symptoms of thyroid diseases, it is necessary:
First of all, come to see a doctor-endocrinologist;
Immediately begin the treatment prescribed by the doctor;
Regularly take medication and strictly follow the directions given by the endocrinologist.
After a complete cure, it is necessary to diagnose the thyroid gland once a year by ultrasound. In addition, it is important to visit a doctor-endocrinologist at least once a year or regularly on the advice of a specialist.