Thyroiditis
Classification according to ICD-10 | |
---|---|
E06 | Thyroiditis |
E06.0 | Acute thyroiditis |
E06.1 | Subacute thyroiditis |
E06.2 | Chronic thyroiditis with transient hyperthyroidism |
E06.3 | Autoimmune thyroiditis Hashimoto's thyroiditis |
E06.4 | Drug-induced thyroiditis |
E06.5 | Other chronic thyroiditis |
E06.9 | Thyroiditis, unspecified |
ICD-10 online (WHO version 2019) |
Thyroiditis ( inflammation of the thyroid gland , also called thyroiditis ) is the technical term for inflammation of the thyroid gland . The term includes several diseases of various causes, some of which differ greatly in their clinical course and prognosis.
Classification
Thyroid diseases can be classified in different ways. A common classification is based on the course of the disease: Acute, subacute and chronic thyroid inflammation can be differentiated. Classifications according to the nature of the pain (painless and painful inflammation of the thyroid gland) and the cause are also common.
Classifications of thyroiditis | ||
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Classification according to time | clinical classification | Classification according to the cause |
Acute thyroiditis | Painful thyroiditis | Immunological genesis |
acute purulent thyroiditis | subacute granulomatous thyroiditis | Hashimoto's thyroiditis |
iatrogenic thyroiditis | acute purulent thyroiditis | Subacute lymphocytic thyroiditis |
subacute thyroiditis | iatrogenic thyroiditis | Riedel's thyroiditis |
subacute granulomatous thyroiditis | Painless thyroiditis | Pathogen-related thyroiditis |
Subacute lymphocytic thyroiditis | Hashimoto's thyroiditis | acute purulent thyroiditis |
Drug-induced thyroiditis | Subacute lymphocytic thyroiditis | subacute granulomatous thyroiditis |
Chronic thyroiditis | Drug-induced thyroiditis | Iatrogenic thyroiditis |
Hashimoto's thyroiditis | Riedel's thyroiditis | other causes |
Riedel's thyroiditis |
Acute thyroiditis
Acute thyroiditis can have several causes.
- Infectious thyroiditis
Infectious thyroiditis is infection by bacteria, fungi, and parasites. In the case of infection by bacteria, the most common form of infectious thyroiditis, a painful, purulent inflammation of the thyroid gland develops within a few days with a pronounced feeling of illness, in which abscesses can form in the thyroid gland. It is also known as acute purulent thyroiditis . With a share of less than 1% in thyroid diseases, acute purulent thyroiditis is a rare disease.
- Iatrogenic thyroiditis
Iatrogenic thyroiditis is thyroiditis caused by medical measures. Acute iatrogenic thyroiditis can occur after fine needle aspiration , after radioiodine therapy , after radiation therapy and after surgery on the organs surrounding the thyroid gland. Acute iatrogenic thyroiditis after radioiodine therapy or after radiation therapy is also known as radiation thyroiditis .
- Paraneoplastic thyroiditis
As a result of tumors and metastases of the thyroid gland (perineoplastic), acute inflammation can also develop in the thyroid tissue.
Subacute thyroiditis
Subacute thyroiditis was first described by Fritz de Quervain in 1904 . Its cause is still unclear to this day; a previous viral infection is suspected. With this disease, "giant cells" form in the tissue, which is why it is also known as giant cell thyroiditis. The main symptom is the pain radiating to the ear and the upper and lower jaw. The pain in the throat often changes from side to side. In addition, the patients suffer from general malaise, fever, fatigue and poor performance, such as with a serious viral infection. Subacute thyroiditis is usually preceded by a respiratory tract infection a few weeks apart . The inflammation causes damage to the thyrocytes. As a result, the thyroid hormone stores are emptied into the blood. The concentration of thyroid hormone in the blood increases significantly. Symptoms in terms of hyperthyroidism are the result. This phase is followed by hypothyroidism, as the damaged thyroid tissue is no longer able to produce new thyroid hormones. The disease usually lasts 1 to 4 months, rarely up to 6 months. The symptoms can be quickly alleviated with appropriate therapy. While a cause-specific therapy is not known, the symptoms can be addressed by administering salicylic acid or diclofenac for mild thyroiditis and glucocorticoids for severe thyroiditis. Attempts to treat hormonal hyperfunction with anti-thyroid drugs are ineffective. Once the thyroid has healed, it usually retains its normal function. Sometimes hypofunction develops, which can be treated by giving thyroid hormone (L- thyroxine ).
Chronic thyroiditis
Chronic thyroiditis is a painless disease that lasts for years and completely or partially destroys tissue. The causes for this are a genetic defect (with familial accumulation) and an autoimmune disease. All symptoms appear slowly and insidiously. Therefore, the disease is usually discovered by chance. The therapy is individually tailored to the patient and the course of the disease. As a result of the disease, an endocrine-disrupting thyroid remains. Therefore, a lifelong substitution (replacement) of thyroid hormones is necessary.
Hashimoto's thyroiditis
The Hashimoto's thyroiditis or struma lymphomatosa Hashimoto is increasing with age focal or diffuse lymphocytic and plasmacytic infiltration of the thyroid gland, forming follicles and germinal centers , which by means of aspiration cytology can be detected. It comes to fibrosis up to the disappearance of the thyroid parenchyma with simultaneous formation of a coarse goiter without knots. This disease is very often associated with other autoimmune diseases (e.g. myasthenia , pernicious anemia , atrophic gastritis).
Hashimoto's thyroiditis takes a clinically normal course with more or less pronounced hypothyroidism , possibly lymphocytosis and increased immunoglobulin. In the acute episode, a hyperthyroid metabolic condition can also occur ("Hashi toxicosis"). The thyroid antibodies TPO-AK and TG-AK are initially elevated. Therapy is primarily through substitution with thyroid hormones. Goiter of any other cause must be ruled out, especially goiter maligna ( thyroid cancer ).
Graves Thyroiditis
Graves 'thyroiditis or Graves' disease is an autoimmune thyroiditis with clinical signs of hyperthyroidism with different degrees of goiter diffusa parenchymatosa, often in combination with endocrine orbitopathy and tachycardia (so-called Merseburg triad). The chronic disease of Graves' disease tends to spontaneous remissions and frequent recurrences . An association with other autoimmune diseases is possible (e.g. vitiligo , rheumatoid arthritis , Crohn's regional enteritis , type 1 diabetes mellitus ).
The thyroid antibody TRAK can be detected, in 60–80% of untreated patients TPO-AK and TGAK can also be detected. Graves' disease can be treated with anti-thyroid drugs , and in the case of recurrent hyperthyroidism, ablative therapy if necessary. The transitions between the individual immunothyreopathies are partly fluid.
Postpartum thyroiditis
The postpartum thyroiditis is an autoimmune thyroiditis in women in the first year after childbirth, often with subclinical hypo- or hyperthyroidism and usually spontaneous remission. Occasionally, there is a transition to Graves' disease or Hashimoto's thyroiditis.
Invasive sclerosing thyroiditis
In invasive sclerosing thyroiditis or Riedel's goiter , the fibrosis of the thyroid gland extends beyond the organ and includes the surrounding tissue and muscles (perithyroidal thyroiditis).
Specific thyroiditis
Specific thyroiditis occurs, for example, in tuberculosis or sarcoid .
literature
- AE Heufelder u. a .: The thyroiditis: current status of pathogenesis, diagnosis and therapy. In: Dtsch Arztebl. 1998; 95 (9), pp. A-466 / B-394 / C-368.