Subacute thyroiditis

Description:

The subacute thyroiditis or de Querven's thyroiditis is the inflammatory disease of a thyroid gland of presumably virus etiology which is followed by destruction of cells of gland. Most often de Querven's thyroiditis occurs at women from 20 to 50 years. At men this disease arises by 5 times less than at women and it is very rare at patients of advanced age and at children.

Symptoms of the Subacute tireodit:

The subacute thyroiditis can sharply begin with rise in body temperature to 38 degrees, pains in a neck amplifying when swallowing, giving to an ear, a mandible, weaknesses, deteriorations in health. But more often the disease begins gradually with an easy indisposition, unpleasant feelings in a neck, a thyroid gland, unpleasant feelings when swallowing. At a ducking and turns of a neck there are pains and unpleasant feelings. There can be pains when chewing, especially firm food. One of shares of a thyroid gland is increased in sizes and is painful at palpation. Usually next lymph nodes are not increased.

A thyroid gland pains almost at a half of patients are followed by a thyrotoxicosis. The thyrotoxicosis always happens average or easy degree. Symptoms from skin, eyes, cardiovascular system are absent. Patients complain of perspiration, increase of heart rate, trembling of fingers of hands, sleeplessness, joint pains. Owing to excess quantity in blood of thyroid hormones (thyroxine, triiodothyronine) allocation by a hypothalamus of hormone of Thyrotropinum which has a promoting effect on a thyroid gland decreases. In the conditions of lack of Thyrotropinum function of the remained most part of a thyroid gland decreases and in the second phase of a disease there comes the hypothyroidism. That is decrease in amount of hormones of a thyroid gland in an organism. Usually the hypothyroidism does not happen expressed and long. Gradually normal level of hormones in blood remains. Duration of a disease makes from 2 to 6 months.

Stages of a subacute thyroiditis
Initial, or acute, the stage proceeds 4-8 weeks and is characterized by pain in a thyroid gland, its morbidity at a palpation, decrease in absorption of a radioiodine a thyroid gland and in certain cases a thyrotoxicosis. An initial stage of a subacute granulematozny thyroiditis also call thyrocardiac.

During an acute stage reserves of thyroid hormones in a thyroid gland are gradually exhausted. When intake of hormones from the destroyed follicles in blood stops, begins the second, or euthyroid, a disease stage.

At many patients the euthyroidism remains, but at a severe disease because of exhaustion of reserves of thyroid hormones and decrease in number of functionally active tirotsit there can come the hypothyroid stage. It is characterized biochemical and in certain cases by clinical signs of a hypothyroidism. At the beginning of a hypothyroid stage absorption of a radioiodine a thyroid gland is reduced, but in the middle or closer to the end of this stage (in process of recovery of structure and function of gland) this indicator gradually increases

The hypothyroid stage is replaced by a recovery stage during which the structure and secretory function of a thyroid gland is finally recovered. At this stage levels of the general T3 and general T4 normal, but absorption of a radioiodine a thyroid gland can temporarily increase because of the strengthened iodine capture by the regenerating follicles. It is necessary to emphasize that the research of absorption of a radioiodine a thyroid gland is necessary only for confirmation of the diagnosis of a subacute granulematozny thyroiditis; after establishment of the diagnosis it is optional to carry out it.

The resistant hypothyroidism after the postponed subacute granulematozny thyroiditis is observed very seldom; almost at all patients function of a thyroid gland is completely recovered (euthyroidism). However recently there was a message on increase in sensitivity of a thyroid gland of the patients who earlier transferred a subacute granulematozny thyroiditis to an inhibiting effect of iodinated medicines. Thus, at the patients who transferred a subacute granulematozny thyroiditis it is necessary to check function of a thyroid gland before purpose of iodinated drugs.

Reasons of the Subacute tireodit:

It is considered that the subacute thyroiditis arises after the postponed viral infection. Usually at first there is a weakness, the general deterioration in health, muscle pain, fervescence, disturbance of work of digestive tract and at the patient the viral infection proceeds. In several weeks or months after recovery there is a subacute thyroiditis. It is confirmed also by the fact that during the periods of outbreaks of viral infections also the frequency of development of a subacute thyroiditis increases. At the same time, now this theory is called in question, but another not yet.

For development of a subacute thyroiditis also hereditary genetic factors which gain value at action of adverse environmental factors in the form of the same viral infection matter. The thyroid gland at a subacute thyroiditis is increased moderately. The center of inflammatory changes usually small also does not occupy all share. As a result of inflammatory changes follicles of a thyroid gland in the center of an inflammation are damaged and broken off.

At this moment there is an emission of hormones of a thyroid gland in blood and there is a thyrotoxicosis. Degree of a thyrotoxicosis depends on amount of the thrown-out hormones, and the amount of the thrown-out hormones depends on the inflammation center sizes. Then gradually there is a scarring of the struck zone.

Treatment of the Subacute tireodit:

Treatment of a subacute tiroidit medicamentous. Generally synthetic glucocorticoid hormones (Prednisolonum, dexamethasone, Kenacortum, Methypredum) are applied. After normalization of a condition of a dose of hormones gradually reduce.

Treatment at an initial, acute stage of a subacute tireodit symptomatic. At slight pain each 3-4 h appoint aspirin in a dose of 600 mg; at severe pain aspirin is usually inefficient. Almost always it is possible to reduce pain by means of Prednisonum (on 10-20 mg in 2 times a day), and the effect, as a rule, occurs in several hours after reception of the first dose. Lack of bystry analgesic effect of Prednisonum calls into question the diagnosis of a subacute granulematozny thyroiditis. In a week begin to lower Prednisonum doses by 5 mg each 2-3 days. Treatment duration Prednisonum should not exceed several weeks. In the course of Prednisonum cancellation pain sometimes amplifies. In such cases of a dose of Prednisonum increase again, and then again reduce. For elimination of symptoms of a thyrotoxicosis appoint propranolol, on 20-40 mg in 3-4 times a day. Anti-thyroid means do not apply.

In an acute stage of a subacute tireodit absorption of a radioiodine a thyroid gland remains reduced. Replacement therapy by thyroid hormones is not required.

The hypothyroid stage of a subacute tireidit seldom lasts more than 2-3 months; at this time carry out replacement therapy by left thyroxine on 0,10-0,15 mg/days inside.

Treatment duration hormonal drugs no more than two months. If disease easy are sometimes limited to purpose of aspirin, indometacin, Voltarenum or Brufenum. At the expressed tirotoksikoz sometimes appoint beta adrenoblockers. Prescription of antibiotics at a subacute tiroidit is contraindicated and can worsen a condition of the patient.

The forecast at this disease good. At timely begun treatment through 2-3mesyaets there occurs recovery. If a disease not to treat it can independently proceed up to two years and pass into a chronic form.