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Subacute Lymphocytic Thyroiditis

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1. Painless lymphocytic thyroiditis

-mediated lymphocytic inflammation of the thyroid gland resulting in a destructive thyroiditis with release of thyroid hormone and transient thyrotoxicosis (hyperthyroidism). Woolf PD. Transient painless thyroiditis with hyperthyroidism: a variant of lymphocytic thyroiditis? Endocr Rev. 1980 Fall;1(4):411-20. http://www.ncbi.nlm.nih.gov/pubmed/7018893?tool=bestpractice.com Samuels MH. Subacute, silent and postpartum thyroiditis. Med Clin North Am. 2012 Mar;96(2):223-33. http://www.ncbi.nlm.nih.gov (...) with hyperthyroidism: a variant of lymphocytic thyroiditis? Endocr Rev. 1980 Fall;1(4):411-20. http://www.ncbi.nlm.nih.gov/pubmed/7018893?tool=bestpractice.com Samuels MH. Subacute, silent and postpartum thyroiditis. Med Clin North Am. 2012 Mar;96(2):223-33. http://www.ncbi.nlm.nih.gov/pubmed/22443972?tool=bestpractice.com Nikolai TF, Brousseau J, Kettrick MA, et al. Lymphocytic thyroiditis with spontaneously resolving hyperthyroidism (silent thyroiditis). Arch Intern Med. 1980 Apr;140(4):478-82. http

2018 BMJ Best Practice

2. Subacute Lymphocytic Thyroiditis

Subacute Lymphocytic Thyroiditis Subacute Lymphocytic Thyroiditis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Subacute Lymphocytic (...) Thyroiditis Subacute Lymphocytic Thyroiditis Aka: Subacute Lymphocytic Thyroiditis , Silent Sporadic Thyroiditis , Painless Sporadic Thyroiditis , Silent Thyroiditis From Related Chapters II. Pathophysiology Autoimmune lymphocytic infiltration of Results in follicle destruction with release of preformed hormone III. Epidemiology More common in women by 4 fold IV. Signs Painless (50%) (up tp 20%) Duration: Typically <4 months Followed by and then euthyroid V. Differential Diagnosis See Nearly identical

2018 FP Notebook

3. Fine-Needle Aspiration of De Quervain’s Thyroiditis (Subacute Granulomatous Thyroiditis): A Cytological Review of 20 Cases (PubMed)

Fine-Needle Aspiration of De Quervain’s Thyroiditis (Subacute Granulomatous Thyroiditis): A Cytological Review of 20 Cases De Quervain's Thyroiditis (DQT) is a self limiting inflammatory disease of the thyroid gland that presents with pain and sore throat. Although the diagnosis is usually made clinically, Fine Needle Aspiration (FNA) may provide assistance, particularly in excluding other thyroid lesions.The objective of this study was to reveal the cytological characteristics of DQT.We (...) followed by epithelioid cell clusters in 15 and colloid in 13 cases.Presence of follicular epithelial cells, large MNGCs and dirty background of cellular debris, mixed inflammatory cells with predominance of lymphocytes and macrophages were the most striking and consistent features for diagnosis of DQT in cytological smears. The above findings in consideration with the clinical history will help us to reach a definitive diagnosis. FNA also proves to be a useful tool in excluding other thyroid lesions

Full Text available with Trip Pro

2017 Journal of clinical and diagnostic research : JCDR

4. Subacute Granulomatous Thyroiditis

lymphocytic thyroiditis and subacute granulomatous thyroiditis. Definition (MSH) Spontaneously remitting inflammatory condition of the THYROID GLAND, characterized by FEVER; MUSCLE WEAKNESS; SORE THROAT; severe thyroid PAIN; and an enlarged damaged gland containing GIANT CELLS. The disease frequently follows a viral infection. Concepts Disease or Syndrome ( T047 ) MSH ICD9 245.1 ICD10 SnomedCT 38727009 , 428041004 , 237533003 , 237532008 , 190296009 , 237530000 , 154666006 , 237531001 English Subacute (...) Subacute Granulomatous Thyroiditis Subacute Granulomatous Thyroiditis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Subacute

2018 FP Notebook

5. Assessment of thyroid mass

observing known microcarcinomas is to use restraint in biopsying lesions less than 1 cm in diameter. Differentials Colloid nodule Thyroid adenoma or hyperplastic nodule, single (solid or complex) Non-toxic multinodular goitre Differentiated thyroid cancer (papillary, follicular) Toxic adenoma, single Toxic multinodular goitre Medullary thyroid cancer Anaplastic thyroid cancer Lymphoma Simple epithelial-lined thyroid cyst Thyroglossal duct cyst Acute suppurative thyroiditis Subacute granulomatous (...) thyroiditis Chronic lymphocytic (Hashimoto's) thyroiditis Painless lymphocytic thyroiditis Graves' disease Enlarged parathyroid gland(s): benign Parathyroid carcinoma Metastasis from non-thyroidal malignancies Contributors Authors Past Chair Surgical Affairs Committee Current Chair Publications Committee American Thyroid Association Executive Board Endocrine Section American Head and Neck Society Professor Department of Otolaryngology-Head and Neck Surgery University of Arkansas for Medical Sciences (UAMS

2019 BMJ Best Practice

6. Overview of thyroid dysfunction

. http://www.ncbi.nlm.nih.gov/pubmed/7018893?tool=bestpractice.com Samuels MH. Subacute, silent, and postpartum thyroiditis. Med Clin North Am. 2012 Mar;96(2):223-33. http://www.ncbi.nlm.nih.gov/pubmed/22443972?tool=bestpractice.com Permanent hypothyroidism may occur. Considered by many to be a variant of chronic lymphocytic (Hashimoto's) thyroiditis. Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmun Rev. 2014 Apr-May;13(4-5):391-7. http (...) in iodine prophylaxis. J Endocrinol Invest. 2003;26(2 Suppl):2-6. http://www.ncbi.nlm.nih.gov/pubmed/12762632?tool=bestpractice.com Autoimmune-mediated inflammation of the thyroid gland with release of thyroid hormone (destructive thyroiditis), resulting in transient hyperthyroidism, frequently followed by a hypothyroid phase before recovery of normal thyroid function. Woolf PD. Transient painless thyroiditis with hyperthyroidism: a variant of lymphocytic thyroiditis? Endocr Rev. 1980 Fall;1(4):411-20

2018 BMJ Best Practice

7. Overview of thyroid dysfunction

. http://www.ncbi.nlm.nih.gov/pubmed/7018893?tool=bestpractice.com Samuels MH. Subacute, silent, and postpartum thyroiditis. Med Clin North Am. 2012 Mar;96(2):223-33. http://www.ncbi.nlm.nih.gov/pubmed/22443972?tool=bestpractice.com Permanent hypothyroidism may occur. Considered by many to be a variant of chronic lymphocytic (Hashimoto's) thyroiditis. Caturegli P, De Remigis A, Rose NR. Hashimoto thyroiditis: clinical and diagnostic criteria. Autoimmun Rev. 2014 Apr-May;13(4-5):391-7. http (...) in iodine prophylaxis. J Endocrinol Invest. 2003;26(2 Suppl):2-6. http://www.ncbi.nlm.nih.gov/pubmed/12762632?tool=bestpractice.com Autoimmune-mediated inflammation of the thyroid gland with release of thyroid hormone (destructive thyroiditis), resulting in transient hyperthyroidism, frequently followed by a hypothyroid phase before recovery of normal thyroid function. Woolf PD. Transient painless thyroiditis with hyperthyroidism: a variant of lymphocytic thyroiditis? Endocr Rev. 1980 Fall;1(4):411-20

2018 BMJ Best Practice

8. Assessment of thyroid mass

observing known microcarcinomas is to use restraint in biopsying lesions less than 1 cm in diameter. Differentials Colloid nodule Thyroid adenoma or hyperplastic nodule, single (solid or complex) Non-toxic multinodular goitre Differentiated thyroid cancer (papillary, follicular) Toxic adenoma, single Toxic multinodular goitre Medullary thyroid cancer Anaplastic thyroid cancer Lymphoma Simple epithelial-lined thyroid cyst Thyroglossal duct cyst Acute suppurative thyroiditis Subacute granulomatous (...) thyroiditis Chronic lymphocytic (Hashimoto's) thyroiditis Painless lymphocytic thyroiditis Graves' disease Enlarged parathyroid gland(s): benign Parathyroid carcinoma Metastasis from non-thyroidal malignancies Contributors Authors Past Chair Surgical Affairs Committee Current Chair Publications Committee American Thyroid Association Executive Board Endocrine Section American Head and Neck Society Professor Department of Otolaryngology-Head and Neck Surgery University of Arkansas for Medical Sciences (UAMS

2018 BMJ Best Practice

9. Thyroid Disease

be an alternative to nuclear medicine for separating thyrotoxicosis that is due to an overactive thyroid, such as Graves disease and toxic adenoma, from thyrotoxicosis, which is due to destructive causes such as subacute or lymphocytic thyroiditis. On Doppler US, these two causes of thyrotoxicosis have increased and decreased thyroid blood flow, respectively [21,22]. Although one study found similar sensitivity and specificity for Doppler US (95% and 90%) and radionuclide uptake studies (90% and 100%) [23 (...) gland. It typically occurs over many years and is more common in women in their fifth and sixth decades of life. Enlargement of the gland can occur with or without nodules and can involve the whole gland symmetrically or predominantly affect one lobe. Thyrotoxicosis is a condition of elevated thyroid hormone production. The most common causes are intrinsic to the thyroid and include Graves disease, toxic adenoma, toxic multinodular goiter, and subacute thyroiditis. Pituitary causes of thyrotoxicosis

2019 American College of Radiology

10. Accumulation of thyroid antigen-reactive T lymphocytes in the gland of patients with subacute thyroiditis. (PubMed)

Accumulation of thyroid antigen-reactive T lymphocytes in the gland of patients with subacute thyroiditis. Blood and thyroid-infiltrating lymphocytes from patients with de Quervain's subacute thyroiditis were tested in the leucocyte migration inhibition test for cell-mediated immunity (CMI) to thyroid antigen. Blood leucocytes were positive for CMI in eleven out of thirteen (85%) patients in the acute phase of the disease. In five cases tested repeatedly this reactivity disappeared after 7-11 (...) months. Thyroid-infiltrating lymphocytes were obtained from eight patients by fine-needle aspiration biopsy. There was a relative accumulation of T lymphocytes (90 +/- 5%) in the thyroid gland as compared to lower numbers of T cells (65 +/- 5%) in the blood. When thyroid-infiltrating lymphocytes were tested for CMI to thyroid antigen, a significantly stronger inhibition was demonstrated with the infiltrating lymphocytes as compared to that of blood leucocytes. We conclude that thyroid antigen

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1978 Clinical and experimental immunology

11. Subacute Lymphocytic Thyroiditis

Subacute Lymphocytic Thyroiditis Subacute Lymphocytic Thyroiditis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Subacute Lymphocytic (...) Thyroiditis Subacute Lymphocytic Thyroiditis Aka: Subacute Lymphocytic Thyroiditis , Silent Sporadic Thyroiditis , Painless Sporadic Thyroiditis , Silent Thyroiditis From Related Chapters II. Pathophysiology Autoimmune lymphocytic infiltration of Results in follicle destruction with release of preformed hormone III. Epidemiology More common in women by 4 fold IV. Signs Painless (50%) (up tp 20%) Duration: Typically <4 months Followed by and then euthyroid V. Differential Diagnosis See Nearly identical

2015 FP Notebook

12. Guidance on the reporting of thyroid cytology specimens

carcinoma cannot be confidently excluded d) a compromised specimen (e.g. obscured by blood, or a poorly spread smear), where some cells appear to be mildly abnormal but are not obviously from a follicular neoplasm or suspicious of, or indicative of, malignancy e) atypical ‘cyst lining cells’ f) predominance of lymphoid cells with very scanty epithelium, provided a lymphocytic thyroiditis has been excluded. In many cases, a repeat thyroid cytology sample is able to be placed into a more definitive (...) Guidance on the reporting of thyroid cytology specimens CEff 200116 1 V5 Final Guidance on the reporting of thyroid cytology specimens January 2016 Authors: Dr Paul Cross, Gateshead Health NHS Foundation Trust (Chair) Dr Ashish Chandra, Guys and St Thomas’s NHS Foundation Trust Dr Thomas Giles, Royal Liverpool and Broadgreen University Hospitals NHS Trust Dr Sarah Johnson, Newcastle upon Tyne Hospitals NHS Foundation Trust Dr Gabrijela Kocjan, University College London Hospitals NHS Foundation

2016 Royal College of Pathologists

13. Guidance on the reporting of thyroid cytology specimens

carcinoma cannot be confidently excluded d) a compromised specimen (e.g. obscured by blood, or a poorly spread smear), where some cells appear to be mildly abnormal but are not obviously from a follicular neoplasm or suspicious of, or indicative of, malignancy e) atypical ‘cyst lining cells’ f) predominance of lymphoid cells with very scanty epithelium, provided a lymphocytic thyroiditis has been excluded. In many cases, a repeat thyroid cytology sample is able to be placed into a more definitive (...) Guidance on the reporting of thyroid cytology specimens CEff 200116 1 V5 Final Guidance on the reporting of thyroid cytology specimens January 2016 Authors: Dr Paul Cross, Gateshead Health NHS Foundation Trust (Chair) Dr Ashish Chandra, Guys and St Thomas’s NHS Foundation Trust Dr Thomas Giles, Royal Liverpool and Broadgreen University Hospitals NHS Trust Dr Sarah Johnson, Newcastle upon Tyne Hospitals NHS Foundation Trust Dr Gabrijela Kocjan, University College London Hospitals NHS Foundation

2016 Royal College of Pathologists

14. CRACKCast E128 – Thyroid and Adrenal Disorders

in the United States is Hashimoto’s thyroiditis, an autoimmune disorder characterized by the presence of thyroid antibodies and lymphocytic infiltration of the thyroid gland. Typically, patients present with a painless goiter and hypothyroidism, but some have transient thyrotoxicosis (hashitoxicosis) that may last a few months. Postpartum thyroiditis Subacute thyroiditis (viral inflammation of the thyroid) Subclinical thyroiditis Factitious thyroiditis (ingestion of excess thyroxine) The categories (...) with other autoimmune diseases, such as diabetes mellitus, pernicious anemia, Addison’s disease, and hyperparathyroidism. Hashimoto’s thyroiditis, or chronic autoimmune lymphocytic thyroiditis, first described in 1912 by Hakaru Hashimoto, is one of the most common organ-specific autoimmune diseases and the most common cause of primary hypothyroidism. It is characterized by infiltration of the thyroid gland by lymphocytic inflammatory cells, which is then often followed by hypothyroidism as a result

2017 CandiEM

15. Subacute Thyroiditis (Treatment)

are not effective in these conditions. Although the abnormal thyroid levels are temporary, emotional support is often necessary. [ , ] Patients are often dehydrated from thyrotoxicosis; encourage all patients to drink 6-8 cups per day of noncaffeinated fluids. Surgical care is almost never recommended for subacute thyroiditis. In rare cases, surgery is recommended for patients who have frequent recurrences of thyrotoxicosis from subacute lymphocytic thyroiditis or recurrent pain from subacute granulomatous (...) if patients are symptomatic. [ ] Subacute granulomatous thyroiditis Patients usually recover completely from subacute granulomatous thyroiditis. The episodes rarely recur. Generally, patients are not prone to other thyroid disease and do not need long-term follow-up. Subacute lymphocytic and subacute postpartum thyroiditis These conditions are sometimes associated with chronic thyroiditis. Postpartum thyroiditis usually recurs after each pregnancy. Patients should be observed routinely every 6-12 months

2014 eMedicine.com

16. Thyroiditis, Subacute (Treatment)

are not effective in these conditions. Although the abnormal thyroid levels are temporary, emotional support is often necessary. [ , ] Patients are often dehydrated from thyrotoxicosis; encourage all patients to drink 6-8 cups per day of noncaffeinated fluids. Surgical care is almost never recommended for subacute thyroiditis. In rare cases, surgery is recommended for patients who have frequent recurrences of thyrotoxicosis from subacute lymphocytic thyroiditis or recurrent pain from subacute granulomatous (...) if patients are symptomatic. [ ] Subacute granulomatous thyroiditis Patients usually recover completely from subacute granulomatous thyroiditis. The episodes rarely recur. Generally, patients are not prone to other thyroid disease and do not need long-term follow-up. Subacute lymphocytic and subacute postpartum thyroiditis These conditions are sometimes associated with chronic thyroiditis. Postpartum thyroiditis usually recurs after each pregnancy. Patients should be observed routinely every 6-12 months

2014 eMedicine.com

17. Thyroiditis, Subacute (Overview)

is important; because it is self-limiting, no specific treatment, such as antithyroid or thyroid hormone replacement therapy, is necessary in most patients. (See Presentation, Workup, and Treatment.) In general, the following three forms of subacute thyroiditis are recognized: Subacute granulomatous thyroiditis - Also known as subacute painful or de Quervain thyroiditis (see the image below) [ ] Subacute lymphocytic thyroiditis - Also known as subacute painless thyroiditis Subacute postpartum thyroiditis (...) . [ ] In one study, as many as 72% of patients with subacute thyroiditis manifested HLA-Bw35. A proposed etiologic mechanism suggests that the disease results from a viral infection that provides an antigen, one that is either viral or that results from virus-induced host tissue damage, that uniquely binds to HLA-B35 molecules on macrophages. The antigen–HLA-B35 complex activates cytotoxic T lymphocytes that damage thyroid follicular cells, because these cells have some structural similarity

2014 eMedicine.com

18. Subacute Thyroiditis (Overview)

is important; because it is self-limiting, no specific treatment, such as antithyroid or thyroid hormone replacement therapy, is necessary in most patients. (See Presentation, Workup, and Treatment.) In general, the following three forms of subacute thyroiditis are recognized: Subacute granulomatous thyroiditis - Also known as subacute painful or de Quervain thyroiditis (see the image below) [ ] Subacute lymphocytic thyroiditis - Also known as subacute painless thyroiditis Subacute postpartum thyroiditis (...) . [ ] In one study, as many as 72% of patients with subacute thyroiditis manifested HLA-Bw35. A proposed etiologic mechanism suggests that the disease results from a viral infection that provides an antigen, one that is either viral or that results from virus-induced host tissue damage, that uniquely binds to HLA-B35 molecules on macrophages. The antigen–HLA-B35 complex activates cytotoxic T lymphocytes that damage thyroid follicular cells, because these cells have some structural similarity

2014 eMedicine.com

19. Thyroiditis, Subacute (Follow-up)

are not effective in these conditions. Although the abnormal thyroid levels are temporary, emotional support is often necessary. [ , ] Patients are often dehydrated from thyrotoxicosis; encourage all patients to drink 6-8 cups per day of noncaffeinated fluids. Surgical care is almost never recommended for subacute thyroiditis. In rare cases, surgery is recommended for patients who have frequent recurrences of thyrotoxicosis from subacute lymphocytic thyroiditis or recurrent pain from subacute granulomatous (...) if patients are symptomatic. [ ] Subacute granulomatous thyroiditis Patients usually recover completely from subacute granulomatous thyroiditis. The episodes rarely recur. Generally, patients are not prone to other thyroid disease and do not need long-term follow-up. Subacute lymphocytic and subacute postpartum thyroiditis These conditions are sometimes associated with chronic thyroiditis. Postpartum thyroiditis usually recurs after each pregnancy. Patients should be observed routinely every 6-12 months

2014 eMedicine.com

20. Subacute Thyroiditis (Follow-up)

are not effective in these conditions. Although the abnormal thyroid levels are temporary, emotional support is often necessary. [ , ] Patients are often dehydrated from thyrotoxicosis; encourage all patients to drink 6-8 cups per day of noncaffeinated fluids. Surgical care is almost never recommended for subacute thyroiditis. In rare cases, surgery is recommended for patients who have frequent recurrences of thyrotoxicosis from subacute lymphocytic thyroiditis or recurrent pain from subacute granulomatous (...) if patients are symptomatic. [ ] Subacute granulomatous thyroiditis Patients usually recover completely from subacute granulomatous thyroiditis. The episodes rarely recur. Generally, patients are not prone to other thyroid disease and do not need long-term follow-up. Subacute lymphocytic and subacute postpartum thyroiditis These conditions are sometimes associated with chronic thyroiditis. Postpartum thyroiditis usually recurs after each pregnancy. Patients should be observed routinely every 6-12 months

2014 eMedicine.com

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