Thyroiditis

Thyroiditis - diseases of the thyroid gland, different in etiology and pathogenesis Inflammation of the diffusely enlarged thyroid gland is called a strum.

Acute thyroiditis is purulent or non-purulent. Can be diffuse and focal. Acute purulent thyroiditis develops against a background of acute or chronic infection (tonsillitis, pneumonia, etc.). Symptoms: pain in the front surface of the neck, radiating to the back of the head, lower and upper jaw, increasing with the movement of the head, swallowing. Increased cervical lymph nodes. Increased fever, chills. With palpation, painful enlargement of a part or whole of the thyroid gland, with a formed abscess - fluctuation. High leukocytosis, shift of the leukocyte formula to the left, increased ESR. When scanning the thyroid gland, a "cold region" is determined, not absorbing the isotope and corresponding to the inflammatory focus. Acute nonsuppurative thyroiditis can develop after trauma, hemorrhage in the gland, radiation therapy. It flows according to the type of aseptic inflammation. Symptomatics is less pronounced than with acute purulent inflammation of the thyroid gland.

Subacute thyroiditis (thyroiditis of de Kerven). Women are more often sick at the age of 30-50 years. Develops after viral infections. Symptoms: pain in the neck, radiating to the occipital region, lower jaw, ears, temporal region. Headache, weakness, adynamia. Temperature increase. Increased ESR, leukocytosis. It can proceed unchanged from the blood. At the beginning of the disease (hyperthyroid, acute stage), symptoms of thyrotoxicosis may be observed: tachycardia, sweating, weight loss, tremor of hands. In the blood - increased levels of thyroid hormones, with scanning-reducing the capture of isotopes by the thyroid gland.

With prolonged course, symptoms of hypothyroidism (hypothyroid stage), drowsiness, lethargy, inhibition, chilliness, swelling of the face, dry skin, bradycardia, constipation may develop. The thyroid gland is enlarged (often only the right lobe), a dense consistency, not soldered to surrounding tissues, painful on palpation. In the blood - a low content of thyroxine and triiodothyronine and a high - thyroid-stimulating hormone.

In the stage of recovery, the soreness of the thyroid gland disappears, the ESR, the levels of thyroid hormones and thyrotropin in the blood are normalized. The disease is prone to recurrence, especially with repeated viral infections, supercooling.

Chronic fibrotic thyroiditis (Riedel's goiter) is a disease of unknown etiology. Symptoms: diffuse, less frequent focal thyroid enlargement. The gland is very dense, immobile, it does not move when swallowed, it is soldered to surrounding tissues. The progression and spread of the process to the entire gland is accompanied by the development of hypothyroidism. When the size of the gland is large, there are symptoms of compression of the neck: hoarseness, difficulty swallowing, breathing. An important diagnostic method is puncture biopsy.

Autoimmune chronic thyroiditis (Hashimoto thyroiditis) -growing, which is based on autoimmune thyroid disease, generates antibodies to various components of the thyroid gland - thyroglobulin, microsomal fraction, receptors for thyrotropin-forming an antigen-antibody complex, development of destructive changes and lymphoid Infiltration of the thyroid gland.

Symptoms: diffuse, sometimes uneven enlargement of the thyroid gland, with palpation of iron of tight-elastic consistency, mobile. With large sizes of the gland, there are symptoms of compression of the neck. As the disease develops, destructive changes lead to impairment of the gland function - at first to the phenomena of hyperthyroidism due to the receipt of a large number of previously synthesized hormones into the blood, then (or bypassing the hyperthyroid phase) - to hypothyroidism. The content of thyroid hormones in the blood is reduced, the thyroid-stimulating hormone - exceeds the norm. In the diagnosis, determination of the titer of antithyroid antibodies, data of puncture biopsy, scanning (characteristic of the isotope absorption irregularity) is of great importance. Absorption of 131I by the thyroid can be reduced, normal or increased (due to the mass of the gland).

Treatment. In acute thyroiditis, antibiotics (penicillin, oletetrine, etc.), symptomatic agents (sedatives, etc.), vitamins C, group B. Abscessed - surgical treatment. With subacute thyroiditis, prolonged use of corticosteroids (prednisolone, dexamethasone, triamcinolone), preparations of salicylic or pyrazolone series against the background of corticosteroid reduction, hyperthyroidism - p-blockers, hypothyroidism - small doses of thyroid hormones. With chronic fibrotic thyroiditis - in the presence of hypothyroidism, substitution therapy with thyroid hormones, with symptoms of compression of the neck organs - surgical treatment.

With chronic autoimmune thyroiditis - treatment with thyroid hormones (triiodothyronine, thyroxine, thyrotomus, thyrotome-forte). In the absence of a decrease in goiter against a background of adequate replacement therapy (3-4 months), corticosteroids (prednisolone 30-40 mg with a gradual decrease in dose) are prescribed for 2-3 months. With fast-growing, painful forms of goiter, large sizes of the thyroid gland with the phenomena of compression of the neck organs-operative baking.