tiroiditis

Tiroiditis (thyroiditis) is an umbrella term for inflammation of the thyroid gland. It includes several conditions that can cause thyroid pain, swelling, and changes in thyroid hormone levels. The most common forms are autoimmune Hashimoto’s thyroiditis, subacute granulomatous thyroiditis (De Quervain), painless or silent thyroiditis, postpartum thyroiditis, and acute infectious thyroiditis. Presentation ranges from a tender, swollen neck to asymptomatic, with either hypothyroidism or hyperthyroidism or temporary fluctuations.

Causes and categories vary by form. Autoimmune thyroiditis (Hashimoto’s) often leads to hypothyroidism over time. Subacute thyroiditis is usually post-viral, often painful, with an initial thyrotoxic phase followed by hypothyroidism and eventual recovery. Painless thyroiditis and postpartum thyroiditis are often autoimmune-related and frequently transient. Acute infectious thyroiditis is rare and requires antimicrobial treatment. Medications such as amiodarone or interferon can also trigger thyroiditis.

Diagnosis rests on clinical assessment and thyroid function testing. Lab tests typically include TSH and free T4 to determine the thyroid state, and thyroid antibodies (such as anti-TPO) when autoimmune disease is suspected. Inflammation markers (CRP or ESR) may be elevated in subacute thyroiditis. Ultrasound helps assess gland structure, and radioactive iodine uptake distinguishes destructive from inflammatory processes. Fine-needle aspiration may be indicated for nodules or suspected infection.

Treatment is tailored to the form and phase. Subacute thyroiditis often responds to NSAIDs or aspirin, sometimes corticosteroids; beta-blockers may control hyperthyroid symptoms. Hashimoto’s, painless, and postpartum thyroiditis may require temporary or long-term thyroid hormone replacement with levothyroxine if hypothyroidism persists. Acute infectious thyroiditis requires antibiotics and drainage if abscess formation occurs. Prognosis varies: many forms resolve over weeks to months, but Hashimoto’s can be chronic and may require ongoing treatment.