subacute thyroiditis
Introduction
Introduction to subacute thyroiditis Subacute thyroiditis, also known as viral thyroiditis, DeQuervain thyroiditis, granulomatous thyroiditis or giant cell thyroiditis, was first reported by DeQuervain in 1904. The disease has gradually increased in recent years, clinical changes are complicated, and misdiagnosis may occur. And missed diagnosis, and easy to relapse, leading to a decline in health, but most patients can be cured, the disease can be characterized by the onset of the season due to seasonal or viral epidemics. basic knowledge Proportion of disease: 20-40 females with a probability of disease 0.064% Susceptible people: this disease is more common in women Mode of infection: non-infectious Complications: hyperthyroidism, insomnia, amenorrhea, impotence, edema
Cause
Cause of subacute thyroiditis
(1) Causes of the disease
Not fully clarified, generally considered to be related to viral infection, the evidence is:
1. Patients have a history of upper respiratory tract infection before onset, and the onset often changes with the season and has a certain prevalence.
2. There is a virus antibody in the blood of the patient (the antibody titer is highly consistent with the disease period), the most common is the Coxsackie virus antibody, followed by the adenovirus antibody, the influenza virus antibody, the mumps virus antibody, etc., although It has been reported that mumps virus is isolated from the thyroid tissue of patients with subacute thyroiditis, but the cause of subacute thyroiditis is that the evidence for the virus has not been found.
In addition, Chinese, Japanese subacute thyroiditis is associated with HLA-Bw35, suggesting a genetic factor for the vulnerability of the virus, but some patients have nothing to do with HLA-Bw35.
(two) pathogenesis
At present, the cause of this disease is mostly related to viral infection, because there is often a history of upper respiratory tract infection before the onset of the disease, or a history of cold or mumps, etc., patients may have fever, sore throat, uncomfortable, fatigue and muscle aches. Such symptoms, and the number of white blood cells does not increase, mumps virus can be detected from the thyroid tissue of the patient, and antibodies against various viruses such as Coxsackie virus, influenza virus, adenovirus and parotid gland can be detected in the blood of patients. Inflammatory virus antibodies, etc., a small number of patients without a history of special infection can detect other viruses and antibodies, and the changes in the titer are related to the course of the disease.
The disease is also an autoimmune disease, because there are reports that 35.1% ~ 42.0% of patients can detect anti-thyroid antigen antibodies and anti-microsomal antibodies, but the titer is not high, it is likely to be subacute thyroiditis Damage caused, it is not certain that its cause, can only indicate the existence of temporary immune system dysfunction in subacute thyroiditis, still to be further studied.
The thyroid gland can be diffuse or nodular, up to twice the normal size, but not too large. The cut surface can be seen as transparent colloid, scattered in the gray lesion area, and many follicular epithelial cells disappear in the early stage. Local epithelial cells and follicular space have inflammatory cells infiltrated, thyroid epithelial cells may have degeneration and necrosis, early focal inflammatory reaction, decreased glial, typical pathological changes of subacute thyroiditis are surrounded by thyroid tissue cells The collagen blocks form giant cells, and most of the follicles form giant cells. At this time, the gelatin is obviously reduced. After the follicular epithelium is regenerated, the giant cells gradually decrease and disappear. As a result, the follicular structure is mutated, it is difficult to recognize, the late inflammation is gradually reduced, and there is lymph. Cell infiltration, follicular regeneration and fibrosis during recovery, lesions can be similar to tuberculous nodules, so it can be called pseudotuberculosis thyroiditis, ie pseudotuberculous thyroiditis, due to its pathological changes, clinically the course of the disease can occur Hyperthyroidism, or hypofunction and normal function, are temporary.
Prevention
Subacute thyroiditis prevention
Enhancing the body's resistance to avoid upper respiratory tract infections and pharyngitis is important to prevent the occurrence of this disease. Subacute thyroiditis is a self-limiting disease that can be relieved by itself, but there are also quite a few patients who need treatment because of symptoms, and enhance the body's resistance to avoid Respiratory tract infections and pharyngitis are important for preventing the occurrence of this disease. Subacute thyroiditis is a self-limiting disease that can be relieved by itself, but a considerable number of patients obviously need treatment because of symptoms.
Complication
Subacute thyroiditis complications Complications, hyperthyroidism, insomnia, amenorrhea, impotence, edema
It can be combined with hyperthyroidism.
Clinical manifestations of hyperthyroidism are: palpitation, tachycardia, fear of heat, excessive sweating, excessive appetite, weight loss, weight loss, fatigue, weakness, emotional excitement, irritability, insomnia, lack of concentration, eyeballs, trembling , goiter or swelling, women may have menstrual disorders or even amenorrhea, men may have impotence or breast development, thyroid enlargement symmetry, and some patients are asymmetric swelling, goiter or swelling assembly with swallowing up and down There are also some patients with hyperthyroidism who have thyroid nodules.
Eye changes caused by hyperthyroidism, one type is benign exophthalmos, the patient's eyeball is prominent, the eye is gazing or showing horrified eyes; the other is malignant exophthalmos, which can be transformed from benign exophthalmos, and patients with malignant exophthalmos are often afraid. Light, tearing, double vision, vision loss, eye swelling, pain, tingling, foreign body sensation, etc., because the eyeball is highly prominent, the eye can not be closed, the conjunctiva, corneal exposure causes congestion, edema, corneal ulceration, and even blindness, Some patients with hyperthyroidism have no ocular symptoms or symptoms. These are the clinical manifestations of typical hyperthyroidism. However, not every hyperthyroidism has all the clinical symptoms. Different types of hyperthyroidism have different clinical manifestations and excessive thyroid hormone secretion. The pathophysiological effects are multifaceted, but the principle of action has not been fully elucidated. In the past, excessive thyroid hormone was thought to act on mitochondria, which has a decoupling effect on the oxidative phosphorylation process, so that the free energy generated by the oxidation process cannot be The form of ATP is depleted and stored, so the oxidation rate increases and the energy supply is insufficient, causing clinical symptoms.
Symptom
Subacute thyroid symptoms common symptoms goiter thyroid function hyperthyroidism low fever high heat tension cold war fatigue heart sore throat
The disease is more common in women, the onset can be urgent, can be slow, the length of the disease varies, can last from several weeks to several months, can also be 1 to 2 years, often recurrence, because the majority of patients with a disease course of 2 to 5 months Therefore, it is called subacute thyroiditis. Before the onset of this disease, there is often a history of upper respiratory tract infection or a history of mumps. When the disease begins, there are many sore throats, headaches, fever (3839°C), chills, tremors, and weakness. Excessive sweating may be accompanied by symptoms of hyperthyroidism, such as palpitations, shortness of breath, irritability, hyperactivity, tremors and increased stools. The goiter may be unilateral or bilaterally enlarged, and may be diffuse or nodular. Swelling, no redness and swelling, but tenderness, painful nature is dull pain, can also be heavier, and can be radiated to the lower jaw, behind the ear, behind the neck or arms, etc., the tenderness is more obvious, so the patient refused to press, a few Patients may also have loss of appetite, hoarseness and neck pressure, and early heart rate, and heart rate is normal. Recurrent patients may reappear symptoms and signs 1 to 2 months after stopping the drug, but before Reduced.
If the patient has fever, short-term goiter with single or multiple nodules, hard and significant tenderness, clinically can be initially diagnosed as this disease, laboratory examination of early erythrocyte sedimentation, white blood cells normal or reduced, blood T3, T4 Increased, and blood TSH decreased, the measured iodine rate can be reduced to 5% to 10% or less, this feature is important for the diagnosis of this disease, blood thyroid immunoglobulin also increased in the early stage, and its recovery is normal than thyroid hormone In the evening, ultrasound examination is a good method for the diagnosis and judgment of its active period. Ultrasound imaging often shows low-density lesions. Cell puncture or tissue biopsy can prove the existence of megakaryocytes.
1. After the recent viral infection, thyroid pain, swelling, may be associated with hyperthyroidism or upper symptoms.
2. The thyroid is diffuse or asymmetrical to moderate to enlarged and tender.
3. Laboratory inspection
(1) Early serum TT3, TT4, FT3, FT4 can be increased, TSH can be reduced, TG-Ab, TPO-Ab can be positive in some patients, and a small number of patients in the later stage can be reduced due to thyroid tissue destruction, serum thyroid hormone levels, TSH Raise.
(2) The rate of 131I in the thyroid gland was significantly reduced, and it showed a "deviation" phenomenon with the increase of serum thyroid hormone levels in the early stage.
(3) ESR is significantly increased, white blood cell count is generally normal or mild to moderately elevated.
Examine
Examination of subacute thyroiditis
Laboratory examination showed mild or moderate elevation of white blood cells. ESR was significantly increased due to destruction of thyroid follicular cells. Thyroid hormone (T) triiodothyronine (T) and thyroglobulin were stored in the follicles. The content of the thyroid follicular cells was reduced, and the iodine absorption rate was decreased; the anti-thyroid antibody in the blood increased little; the thyroid stimulating hormone decreased.
Blood routine examination of the total number of white blood cells is generally normal or slightly higher, erythrocyte sedimentation rate, protein electrophoresis on the paper shows elevated globulin levels, especially 2 globulin, thyroid function test often 131I iodine absorption rate decreased, plasma protein binding iodine Elevated, total T3, T4 levels increased or normal, TSH levels decreased, some patients in the late T3, T4 levels were low or normal, TGA positive, some TMA can also be positive, when the symptoms of subacute thyroiditis disappeared, After thyroid function and biochemical examination are normal, serum TGA can still be positive, and the disease can exist in a subclinical form for a long period of time.
1. Thyroid B ultrasound.
2. Thyroid to take 131I rate.
3. Thyroid scans often show signs of cold nodules or sparse distribution of radioactivity.
Diagnosis
Diagnosis and diagnosis of subacute thyroiditis
Subacute thyroiditis requires acute hemorrhage with thyroid nodules, acute onset of chronic lymphocytic thyroiditis, differentiation of silent or painless thyroiditis and acute suppurative thyroiditis, bleeding in multiple nodular goiter When it comes out to the nodule, it is not difficult to identify, because it can touch the nodules on the thyroid gland at this time; when bleeding to a single thyroid nodule, it is more difficult to identify, in the above two types of bleeding, other than the lesion The function of thyroid tissue still exists, and its erythrocyte sedimentation rate is significantly increased. The acute onset of chronic lymphocytic thyroiditis may be accompanied by thyroid pain and tenderness, but the gland is mostly violated, and the anti-thyroid antibody in the blood is mostly elevated. Patients with hyperthyroidism need to be differentiated from toxic diffuse goiter. However, the rate of 131I in the thyroid gland is increased, painless thyroiditis with hyperthyroidism, and low iodine iodine rate, pathology Chronic thyroiditis, when there is no giant cells, often called hyperthyroiditis, compared with the identification of painless thyroiditis Difficulties, erythrocyte sedimentation rate does not increase, the anti-thyroid antibody is significantly increased, suggesting that the former, acute suppurative thyroiditis, there are sepsis lesions in other parts of the body, the adjacent tissue of the thyroid has obvious infection reaction, white blood cells rise significantly High, and have a fever reaction, the radioactive iodine uptake function of acute suppurative thyroiditis still exists, subacute thyroiditis rarely needs to be differentiated from thyroid cancer, which is widely violated by thyroid gland, because both clinical and laboratory tests are very common. Not the same.
