This type of thyroiditis is the most common and is more common in women aged 30-50!

Author: Wei Junping, Chief Physician, Guang'anmen Hospital, China Academy of Chinese Medical Sciences

Reviewer: Mao Yonghui, Chief Physician, Beijing Hospital

Thyroiditis is a group of inflammatory diseases caused by thyroid destruction or necrosis due to various reasons, including bacterial, viral, fungal infections, autoimmune diseases, trauma, radiation factors, etc.

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The thyroid gland is an organ that synthesizes and secretes thyroid hormones. If the thyroid structure is damaged or even necrotic, it will affect the synthesis and secretion of thyroid hormones, affect thyroid function, and lead to hyperthyroidism or hypothyroidism.

1. What are the types of thyroiditis?

Thyroiditis is divided into acute thyroiditis, subacute thyroiditis and chronic thyroiditis according to the severity of onset. The so-called acute, subacute and chronic thyroiditis cannot be transformed into each other, and the causes, clinical manifestations, pathology and prognosis are all different.

Acute thyroiditis mainly refers to acute suppurative inflammation, including bacterial and fungal infections; subacute thyroiditis is mainly related to viral infections, such as granulomatous thyroiditis and giant cell thyroiditis. It usually occurs one to two weeks after a cold, so it is called subacute thyroiditis; chronic thyroiditis is mainly chronic inflammation of the thyroid gland caused by autoimmune abnormalities.

Thyroiditis is classified into autoimmune thyroiditis and non-autoimmune thyroiditis according to the cause. Autoimmune thyroiditis, such as chronic lymphocytic thyroiditis, also known as Hashimoto's thyroiditis, is the most common in clinical practice. Atrophic thyroiditis, painless thyroiditis, and postpartum thyroiditis are also relatively common in outpatient clinics; non-autoimmune thyroiditis usually refers to radiation thyroiditis, traumatic thyroiditis, and infectious thyroiditis.

Autoimmune thyroiditis is relatively common at present, and Hashimoto's thyroiditis is the most common among autoimmune thyroiditis.

2. Who is prone to Hashimoto’s thyroiditis?

Hashimoto's thyroiditis is a chronic autoimmune disease with the thyroid gland's own tissue as an antigen. Why is it named Hashimoto's? Because the first person to discover this disease was a Japanese scholar named Hashimoto, so it was named after him.

Hashimoto's thyroiditis is common in women aged 30-50. It is related to genetics and has a familial clustering. Sometimes several generations in a family are sick at the same time. It is common to see two sisters or a mother and daughter coming to see a doctor together in the outpatient clinic.

In addition, research data shows that people who live in iodine-rich or high-iodine areas for a long time are more likely to suffer from Hashimoto's thyroiditis. People in iodine-rich areas have higher levels of thyroglobulin antibodies than people in other areas. This shows that the incidence of Hashimoto's thyroiditis is higher in people with excessive iodine.

People who are deficient in selenium are also prone to Hashimoto's thyroiditis. Selenium is involved in the synthesis and storage of thyroid hormones and is a very important trace element. Long-term mental stress and excessive radiation exposure to the thyroid gland can also easily induce Hashimoto's thyroiditis.

3. What are the symptoms of Hashimoto’s thyroiditis?

Most cases of Hashimoto's thyroiditis present with an enlarged thyroid gland, which is often diffuse and symmetrical, but can also be unilateral. An enlarged thyroid gland can cause a foreign body sensation, especially when swallowing food. Compression of the trachea can also cause difficulty breathing. An enlarged thyroid gland generally does not compress the recurrent laryngeal nerve and does not cause hoarseness.

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In the early stages, Hashimoto's thyroiditis may cause transient hyperthyroidism, called Hashimoto's hyperthyroidism. It is not true hyperthyroidism, but thyrotoxicosis. The clinical manifestations are the same as hyperthyroidism, including palpitations, hand tremors, sweating, increased bowel movements, etc.

In the later stages, Hashimoto's thyroiditis mainly manifests itself as symptoms of hypothyroidism. Due to insufficient secretion of thyroid hormones, metabolism slows down. Common clinical symptoms are constipation, bloating after meals, rough skin, slow heart rate, chest tightness and shortness of breath, fear of cold, and often feeling weak and tired.

When a goiter occurs, the first thing to do is to check the thyroid function. The important indicators for diagnosing Hashimoto's thyroiditis are thyroid peroxidase antibodies and thyroglobulin antibodies. Further thyroid B-ultrasound, thyroid radionuclide, thyroid iodine uptake rate, and thyroid fine needle aspiration cytology can also be done to help confirm the diagnosis.

If Hashimoto's thyroiditis causes symptoms of pseudohyperthyroidism, symptomatic treatment is required, using heart rate control drugs to slow down the heart rate. Antithyroid drugs are not recommended. If they are used, the dose should be small, the course of treatment should be short, and the treatment should be stopped when the disease is cured to avoid the occurrence of hypothyroidism. If Hashimoto's thyroiditis causes symptoms of hypothyroidism, drugs are also needed to control it.