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Thyroiditis

 

Causes:

  • Postpartum
  • Drug induced
  • Viral/Subacute (de Quervain’s)
  • Radiation
  • Autoimmune (Hashimotos)


The first four of these are temporary and the thyroid usually but not always returns to normal. However Autoimmune thyroiditis can typically lead to persistent hypothyroidism.

 


Red flags

  • Thyroid storm- admit as medical emergency
  • Suspected thyroid malignancy – refer on 2ww head and neck pathway

 

 

Subacute/ de Quervains

Has triphasic course:       Transient thyrotoxic→ hypothyroid (weeks/months)→ +/- euthyroid

 

Mainly women 20-50yrs

Normally triggered by viral infection

May present with fever & thyroid pain (tender firm enlarged thyroid) +/- signs hyperthyroidism +/- sore throat/ flu like symptoms

Usually recovery takes 2-5 months

5-20% develop persistent hypothyroidism

 


Management

Thyrotoxic phase is self-limiting and should be managed symptomatically:


If thyrotoxic- refer the Endocrinology but whilst patient pending to be seen:

If palpitations/tremor- consider B blockers

If pain - consider NSAIDS

If persistent symptoms-consider steroids-please use Endocrinology A&G for advice

 

Also see guidance hyperthyroidism / hypothyroidism


If concerns/queries, please use Endocrine A&G for advice.

 


Postpartum thyroiditis

Normally within first 6months postpartum

Presents painless mildly swollen thyroid, with temporary hyperthyroidism, that resolves spontaneously.

Classically triphasic: transient hyperthyroidism→ hypothyroid (up to 1yr) → +/-euthyroid

c.20% progress to permanent hypothyroidism

Postnatal hypothyroidism may present as postnatal depression/lactation difficulties

Risk factors include: Type 1 Diabetes Mellitus, Chronic hepatitis, Personal or Fhx of other autoimmune disease, known anti TPO autoab

 

Increased lifetime risk of hypothyroidism- advise annual TFTS

 

If hyperthyroidism - refer Endocrinology


Normally self limiting-temporary B blockers if symptomatic- propranolol- low risk if breastfeeding

 

If hypothyroid:

If TSH>10- treat levothyroxine

If TSH raised but <10- treat levothyroxine if symptomatic

If TSH mildly raised but asymptomatic and low risk of further pregnancy- monitor-rpt TFTS 8 weeks

 

If concerns/queries- contact Endocrinology via  Advice and guidance

 

Patient resources

https://www.btf-thyroid.org/thyroiditis

 

 

References

BMJ Best Practice, Subacute Thyroiditis, March 2018

NICE CKS Hyperthyroidism January 2021

NICE CKS Hypothyroidism May 2021

BMJ Best Practice- Postpartum Thyroiditis March 2021

 

Contributors:

Dr Duncan Browne, Consultant Endocrinologist, RCHT

Dr Bridgitte Wesson, GP and Kernow RMS Endocrinology Guideline Lead

 

Guidelines review 07/02/2022

Next review due    07/02/2023