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Friday, 29 November 2013

Thyroid Disease : Silent thyroiditis – The Complications

Thyroid disease is defined as a condition of malfunction of thyroid. Hyperthyroidism is a condition in which the thyroid gland is over active and produces too much thyroid hormones. Hypothyroidism is a condition in which the thyroid gland is under active and produces very little thyroid hormones. Thyroid cancer is defined as condition in which the cells in the thyroid gland have become cancerous.
Silent thyroiditis
Silent thyroiditis is the inflammation of the thyroid gland. Patients with silent thyroiditis are experience back and forth between hypothyroidism and hyperthyroidism. The disease classically present with a triphasic course: a brief period of thyrotoxicosis due to release of preformed thyroid hormone that lasts for 1 to 3 months, followed by a more prolonged hypothyroid phase lasting up to 6 months, and eventual return to a euthyroid state. However, the types and degree of thyroid dysfunction are variable in these disorders, and individual patients may present with mild or more severe cases of thyrotoxicosis alone, hypothyroidism alone, or both types of thyroid dysfunction(a).
C.1. Complications
1. Sudden unexpected death
In a forensic autopsy study comprising 125 cases was carried out retrospectively in order to evaluate pathological changes in the thyroid gland in different groups of death, showed that the most striking result was the finding of extensive lymphocytic infiltration of the thyroid parenchyma in five of the 124 cases, of which four belonged in the group of ‘unknown cause of death’. This discovery leads to reflections regarding lymphocytic thyroiditis as a cause of death, either by itself or in combination with other disorders. Silent (painless) thyroiditis, especially, is easily overlooked at autopsy as there are no macroscopic changes and often no prior symptoms or history of thyroid disease pointing towards this condition(23).
2. Oncocytic follicular nodules
Oncocytic follicular (OF) cells can be a prominent component of fine needle aspiration (FNA) specimens from neoplasms (adenomas and carcinomas) and nodules arising in multinodular goiter and chronic lymphocytic thyroiditis (CLT)(24).
3. Recurrent Silent thyroiditis (ST)
Silent thyroiditis (ST) recurred with a high incidence (65%, 35/54), according to the study by the Department of Endocrinology and Metabolism, Toranomon Hospital(25).
4. Hashimoto’s thyroiditis
In the study of twenty-six specimens obtained from 23 patients with clinically and laboratory-proven silent thyroiditis were examined histologically; 11 specimens were obtained during the thyrotoxic phase, and 15 specimens during the early or late recovery phase. All specimens showed chronic thyroiditis, focal or diffuse type; and lymphoid follicles were present in about half of the specimens(26).
5. Thyrotoxicosis
There is a report of a 3 patients (2 male, 1 female) presented with symptoms of thyrotoxicosis associated with elevated blood-levels of thyroid hormone and a markedly depressed thyroidal uptake of 131-I. The male patients (aged 59 and 47) each had a cardiac arrhythmia, but did not have any thyroid pain or swelling. The female with a goitre had no discomfort in the neck. Thyrotoxicosis factitia was excluded by history. The subsequent course of their disease was typical of subacute thyroiditis(27).
6. Left ventricular rupture
There is a report of a case of left ventricular rupture and formation of a pseudoaneurysm after silent myocardial infarction in a patient with Schmidt syndrome (polyglandular deficiency syndrome including Addison’s disease, lymphocytic thyroiditis and diabetes mellitus)(28).
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Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/22443972
(23c) http://www.ncbi.nlm.nih.gov/pubmed/15826919
(23) http://www.ncbi.nlm.nih.gov/pubmed/17520957
(24) http://www.ncbi.nlm.nih.gov/pubmed/17520957
(25) http://www.ncbi.nlm.nih.gov/pubmed/10483248
(26) http://www.ncbi.nlm.nih.gov/pubmed/3284807
(27) http://www.ncbi.nlm.nih.gov/pubmed/46512
(28) http://www.ncbi.nlm.nih.gov/pubmed/7558468