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Subacute Lymphocytic Thyroiditis

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21. Subacute Thyroiditis (Diagnosis)

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

22. Thyroiditis, Subacute (Diagnosis)

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

23. Lymphocytic (auto-immune, Hashimoto's) thyroiditis. Presentation of an unusual case with subacute onset in a 14-year-old girl. (PubMed)

Lymphocytic (auto-immune, Hashimoto's) thyroiditis. Presentation of an unusual case with subacute onset in a 14-year-old girl. 4870576 1968 07 10 2018 11 13 1468-2044 43 227 1968 Feb Archives of disease in childhood Arch. Dis. Child. Lymphocytic (auto-immune, Hashimoto's) thyroiditis. Presentation of an unusual case with subacute onset in a 14-year-old girl. 80-8 Humbert J R JR Gotlin R W RW Hostetter G G Sherrill J G JG Silver H K HK eng Case Reports Journal Article England Arch Dis Child (...) 0372434 0003-9888 0 Autoantibodies 9010-34-8 Thyroglobulin IM Adolescent Autoantibodies analysis Complement Fixation Tests Female Fluorescent Antibody Technique Humans Hypothyroidism etiology Thyroglobulin analysis Thyroid Gland pathology Thyroiditis, Autoimmune epidemiology immunology 1968 2 1 1968 2 1 0 1 1968 2 1 0 0 ppublish 4870576 PMC2019920 J Clin Endocrinol Metab. 1956 Dec;16(12):1570-9 13385305 J Pediatr. 1965 Jan;66:73-8 14250058 Br Med J. 1960 Feb 6;1(5170):365-73 13817519 J Clin Endocrinol

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1968 Archives of Disease in Childhood

24. AACE/ACE/AME Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules

AACE/ACE/AME Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules ENDOCRINE PRACTICE Vol 22 (Suppl 1) May 2016 1 AACE/ACE/AME Guidelines AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES – 2016 UPDATE APPENDIX Hossein Gharib, MD, MACP , MACE 1 , Co-Chair; Enrico Papini, MD, FACE 2 , Co-Chair (...) ; Jeffrey R. Garber, MD, FACP , FACE 3 ; Daniel S. Duick, MD, FACP , FACE 4 ; R. Mack Harrell, MD, FACP , FACE, ECNU 5 ; Laszlo Hegedüs, MD 6 ; Ralf Paschke, MD 7 ; Roberto Valcavi, MD, FACE 8 ; Paolo Vitti, MD 9 ; on behalf of the AACE/ACE/AME Task Force on Thyroid Nodules* American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE) and Associazione Medici Endocrinologi (AME) Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid

2016 American Association of Clinical Endocrinologists

25. 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

2015 FP Notebook

26. Thyroiditis

, causing hypothyroidism (too little thyroid hormone). A temporary form of thyroiditis may also occur after the birth of a baby, or when viral or bacterial infections spread to the thyroid. Definition (CSP) inflammation of the thyroid gland. Definition (MSH) Inflammatory diseases of the THYROID GLAND. Thyroiditis can be classified into acute (THYROIDITIS, SUPPURATIVE), subacute (granulomatous and lymphocytic), chronic fibrous (Riedel's), chronic lymphocytic (HASHIMOTO DISEASE), transient (POSTPARTUM (...) Derived from the NIH UMLS ( ) Ontology: Thyroiditis (C0040147) Definition (CHV) inflammation of the thyroid gland Definition (CHV) inflammation of the thyroid gland Definition (NCI) Inflammation of the thyroid gland. This category includes Hashimoto thyroiditis, Riedel thyroiditis, acute thyroiditis, subacute thyroiditis, and radiation-induced thyroiditis. Definition (NCI_NCI-GLOSS) Inflammation of the thyroid gland. Thyroiditis may be an autoimmune disease that affects the thyroid gland over time

2018 FP Notebook

27. Thyroid, Evaluation of Solitary Thyroid Nodule

manifestations are goiter and hypothyroidism. Subacute granulomatous thyroiditis is probably viral in origin, and patients usually present with a tender goiter. Subacute lymphocytic thyroiditis is of unknown pathogenesis, but the postpartum form may be autoimmune. Its principal manifestations are goiter and spontaneously reversible hyperthyroidism. Acute suppurative thyroiditis results from bacterial or fungal infection causing abscess. Riedel struma, a disease of unknown cause, manifests with a goiter (...) and symptoms of altered metabolic function can help establish the correct diagnosis. Generally, most thyroid nodules are benign and can be classified as adenomas, colloid nodules, congenital abnormalities, cysts, infectious nodules, lymphocytic or granulomatous nodules, or hyperplasia. Previous Next: Benign Thyroid Nodules Thyroid adenomas Thyroid adenomas are benign neoplasms, which are usually classified as follicular or papillary. Follicular adenomas are the most common type of adenomas and arise from

2014 eMedicine Surgery

28. Subacute Thyroiditis

Subacute Thyroiditis Subacute Thyroiditis - Endocrine and Metabolic Disorders - MSD Manual Professional Edition Brought to you by The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases The trusted provider of medical information since 1899 SEARCH SEARCH MEDICAL TOPICS Common Health Topics Resources QUIZZES & CASES Quizzes Cases / / / / IN THIS TOPIC OTHER TOPICS IN THIS CHAPTER Test your knowledge Overview (...) Overview of Respiratory Acidosis SOCIAL MEDIA Add to Any Platform Loading , MD, MS, David Geffen School of Medicine at UCLA Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Subacute thyroiditis is an acute inflammatory disease of the thyroid probably caused by a virus. Symptoms include fever and thyroid tenderness. Initial hyperthyroidism is common, sometimes followed by a transient period of hypothyroidism. Diagnosis is clinical and with thyroid function tests

2013 Merck Manual (19th Edition)

29. Thyroidectomy for Painful Thyroiditis Resistant to Steroid Treatment: Three New Cases with Review of the Literature (PubMed)

Thyroidectomy for Painful Thyroiditis Resistant to Steroid Treatment: Three New Cases with Review of the Literature Thyroidal pain is usually due to subacute thyroiditis (SAT). In more severe forms prednisone doses up to 40 mg daily for 2-3 weeks are recommended. Recurrences occur rarely and restoration of steroid treatment cures the disease. Rarely, patients with Hashimoto's thyroiditis (HT) have thyroidal pain (painful HT, PHT). Differently from SAT, occasional PHT patients showed no benefit (...) features of granulomatous thyroiditis, typical of SAT, without fibrosis or lymphocytic infiltration, typical of HT/PHT, coupled to undetectable serum anti-thyroid antibodies. Our data (1) suggest that not only PHT but also SAT may show resistance to steroid treatment and (2) confirm a previous observation in a single PHT patient that increasing prednisone doses above conventional maximal dosages may not be useful in these patients.

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2015 Case reports in endocrinology

30. Silent Lymphocytic Thyroiditis

Model Female Endocrine System Video Overview of Physiologic pH and Buffers SOCIAL MEDIA Add to Any Platform Loading , MD, MS, David Geffen School of Medicine at UCLA Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources Silent lymphocytic thyroiditis is a self-limited, subacute disorder occurring most commonly in women during the postpartum period. Symptoms are initially of hyperthyroidism, then hypothyroidism, and then generally recovery (...) , often followed by transient hypothyroidism due to depleted thyroid hormone stores but usually eventual recovery to the euthyroid state (as noted for painful subacute thyroiditis). The hyperthyroid phase is self-limited and may be brief or overlooked. Many women with this disorder are diagnosed when they become hypothyroid, which occasionally is permanent. Diagnosis Clinical evaluation Serum thyroxine (T 4 ), triiodothyronine (T 3 ), and thyroid-stimulating hormone (TSH) levels Silent lymphocytic

2013 Merck Manual (19th Edition)

31. Lymphocytic Interstitial Pneumonia (Diagnosis)

and physiologically unaffected patients may not require treatment. Symptomatic patients may require supportive care and immunosuppressives, chiefly corticosteroids. Occasionally, cytotoxic therapy has been used. No controlled treatment trials have been reported. [ ] In pediatric patients with HIV, empiric treatment for lymphocytic interstitial pneumonia (LIP) often is initiated based on the findings of subacute dyspnea, mild hypoxemia, and clubbing. Medications should be used in patients who are symptomatic (...) Lymphocytic Interstitial Pneumonia (Diagnosis) Lymphocytic Interstitial Pneumonia: Overview, Pathophysiology and Etiology, Epidemiology Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjk5NjQzLW92ZXJ2aWV3

2014 eMedicine.com

32. Lymphocytic Interstitial Pneumonia (Overview)

and physiologically unaffected patients may not require treatment. Symptomatic patients may require supportive care and immunosuppressives, chiefly corticosteroids. Occasionally, cytotoxic therapy has been used. No controlled treatment trials have been reported. [ ] In pediatric patients with HIV, empiric treatment for lymphocytic interstitial pneumonia (LIP) often is initiated based on the findings of subacute dyspnea, mild hypoxemia, and clubbing. Medications should be used in patients who are symptomatic (...) Lymphocytic Interstitial Pneumonia (Overview) Lymphocytic Interstitial Pneumonia: Overview, Pathophysiology and Etiology, Epidemiology Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjk5NjQzLW92ZXJ2aWV3 processing

2014 eMedicine.com

33. Lymphocytic Interstitial Pneumonia (Follow-up)

and physiologically unaffected patients may not require treatment. Symptomatic patients may require supportive care and immunosuppressives, chiefly corticosteroids. Occasionally, cytotoxic therapy has been used. No controlled treatment trials have been reported. [ ] In pediatric patients with HIV, empiric treatment for lymphocytic interstitial pneumonia (LIP) often is initiated based on the findings of subacute dyspnea, mild hypoxemia, and clubbing. Medications should be used in patients who are symptomatic (...) Lymphocytic Interstitial Pneumonia (Follow-up) Lymphocytic Interstitial Pneumonia: Overview, Pathophysiology and Etiology, Epidemiology Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjk5NjQzLW92ZXJ2aWV3

2014 eMedicine.com

34. Lymphocytic Interstitial Pneumonia (Treatment)

and physiologically unaffected patients may not require treatment. Symptomatic patients may require supportive care and immunosuppressives, chiefly corticosteroids. Occasionally, cytotoxic therapy has been used. No controlled treatment trials have been reported. [ ] In pediatric patients with HIV, empiric treatment for lymphocytic interstitial pneumonia (LIP) often is initiated based on the findings of subacute dyspnea, mild hypoxemia, and clubbing. Medications should be used in patients who are symptomatic (...) Lymphocytic Interstitial Pneumonia (Treatment) Lymphocytic Interstitial Pneumonia: Overview, Pathophysiology and Etiology, Epidemiology Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMjk5NjQzLW92ZXJ2aWV3

2014 eMedicine.com

35. Thyroid Cancer

likely to be malignant in patients older than 60 years and in patients younger than 30 years Increased rate of malignancy in males Nodular growth Rapid growth: Ominous sign Usually painless (nontender to palpation); sudden onset of pain more strongly associated with benign disease (eg, hemorrhage into a benign cyst, subacute viral thyroiditis) Hard and fixed nodules Diagnosis The key to the workup of the solitary thyroid nodule is to differentiate malignant from benign disease and, thus, to determine (...) growth is an ominous sign. Malignant thyroid nodules are usually painless. Sudden onset of pain is more strongly associated with benign disease, such as hemorrhage into a benign cyst or subacute viral thyroiditis, than with malignancy. Hoarseness suggests involvement of the recurrent laryngeal nerve and vocal fold paralysis. Dysphagia may be a sign of impingement of the digestive tract. Heat intolerance and palpitations suggest autonomously functioning nodules. Medullary carcinoma can occur as part

2014 eMedicine Surgery

36. De Quervain Thyroiditis (Diagnosis)

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

37. Thyroid Ophthalmopathy (Treatment)

-stimulating hormone (TSH) receptor [ ] with orbital fibroblast modulation of T-cell lymphocytes. T-cell lymphocytes are believed to react against thyroid follicular cells with shared antigenic epitopes in the retroorbital space. An active phase of inflammation is initially present. Lymphocytic infiltration, fibroblast reaction, and increased orbital volume Lymphocytic infiltration of the orbital tissue causes a release of cytokines (eg, tumor necrosis factor [TNF], interleukin 1 [IL-1]) from CD4+ T cells (...) . [ ] Previous Next: Clinical Evaluation Thyroid-associated orbitopathy (thyroid ophthalmopathy) usually has a self-limited course over 1 or more years. Stable disease can occasionally reactivate, but this is uncommon. Signs and symptoms may vary and depend on the stage that the patient is experiencing. Initially, an acute or subacute stage of active inflammation occurs. Later, the patient progresses to a more quiescent stage, which is characterized by fibrosis. [ ] Symptoms Patients may complain

2014 eMedicine.com

38. Thyroid Ophthalmopathy (Overview)

-stimulating hormone (TSH) receptor [ ] with orbital fibroblast modulation of T-cell lymphocytes. T-cell lymphocytes are believed to react against thyroid follicular cells with shared antigenic epitopes in the retroorbital space. An active phase of inflammation is initially present. Lymphocytic infiltration, fibroblast reaction, and increased orbital volume Lymphocytic infiltration of the orbital tissue causes a release of cytokines (eg, tumor necrosis factor [TNF], interleukin 1 [IL-1]) from CD4+ T cells (...) . [ ] Previous Next: Clinical Evaluation Thyroid-associated orbitopathy (thyroid ophthalmopathy) usually has a self-limited course over 1 or more years. Stable disease can occasionally reactivate, but this is uncommon. Signs and symptoms may vary and depend on the stage that the patient is experiencing. Initially, an acute or subacute stage of active inflammation occurs. Later, the patient progresses to a more quiescent stage, which is characterized by fibrosis. [ ] Symptoms Patients may complain

2014 eMedicine.com

39. De Quervain 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

40. De Quervain 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

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