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Subacute Lymphocytic Thyroiditis

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41. 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

42. De Quervain 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

43. 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

44. Thyroiditis (Treatment)

and Hashimoto's thyroiditis: a shared plot?. Int J Colorectal Dis . 2015 Aug 23. . Tomer Y, Dolan LM, Kahaly G, Divers J, D'Agostino RB Jr, et al. Genome wide identification of new genes and pathways in patients with both autoimmune thyroiditis and type 1 diabetes. J Autoimmun . 2015 Jun. 60:32-9. . Media Gallery Three multinuclear, giant cell granulomas observed in a fine-needle aspiration biopsy of the thyroid; from a patient with thyrotoxicosis from lymphocytic or subacute granulomatous thyroiditis. of 1 (...) , cephalosporins are appropriate. Patients with acute thyroiditis may require inpatient care to complete 10-14 days of antibiotics. Subacute thyroiditis Subacute thyroiditis is self-limiting; therefore, the goals of treatment are to relieve discomfort and to control the abnormal thyroid function. The discomfort can usually be relieved with low-dose aspirin (divided every 4-6 h). In the rare cases that aspirin does not relieve the discomfort, administer prednisone for 1 week and then taper. Propranolol can

2014 eMedicine Pediatrics

45. Thyroiditis (Overview)

is the most common of these 3 types. The second form of thyroiditis, Riedel struma, is rare in children. Secondary thyroiditis may be due to the administration of amiodarone to treat cardiac arrhythmias or the administration of interferon-alpha to treat viral diseases. Three multinuclear, giant cell granulomas observed in a fine-needle aspiration biopsy of the thyroid; from a patient with thyrotoxicosis from lymphocytic or subacute granulomatous thyroiditis. Diagnosis Laboratory test results vary (...) . . Mormile R. Celiac disease and Hashimoto's thyroiditis: a shared plot?. Int J Colorectal Dis . 2015 Aug 23. . Tomer Y, Dolan LM, Kahaly G, Divers J, D'Agostino RB Jr, et al. Genome wide identification of new genes and pathways in patients with both autoimmune thyroiditis and type 1 diabetes. J Autoimmun . 2015 Jun. 60:32-9. . Media Gallery Three multinuclear, giant cell granulomas observed in a fine-needle aspiration biopsy of the thyroid; from a patient with thyrotoxicosis from lymphocytic or subacute

2014 eMedicine Pediatrics

46. Thyroiditis (Follow-up)

and Hashimoto's thyroiditis: a shared plot?. Int J Colorectal Dis . 2015 Aug 23. . Tomer Y, Dolan LM, Kahaly G, Divers J, D'Agostino RB Jr, et al. Genome wide identification of new genes and pathways in patients with both autoimmune thyroiditis and type 1 diabetes. J Autoimmun . 2015 Jun. 60:32-9. . Media Gallery Three multinuclear, giant cell granulomas observed in a fine-needle aspiration biopsy of the thyroid; from a patient with thyrotoxicosis from lymphocytic or subacute granulomatous thyroiditis. of 1 (...) , cephalosporins are appropriate. Patients with acute thyroiditis may require inpatient care to complete 10-14 days of antibiotics. Subacute thyroiditis Subacute thyroiditis is self-limiting; therefore, the goals of treatment are to relieve discomfort and to control the abnormal thyroid function. The discomfort can usually be relieved with low-dose aspirin (divided every 4-6 h). In the rare cases that aspirin does not relieve the discomfort, administer prednisone for 1 week and then taper. Propranolol can

2014 eMedicine Pediatrics

47. Thyroiditis (Diagnosis)

is the most common of these 3 types. The second form of thyroiditis, Riedel struma, is rare in children. Secondary thyroiditis may be due to the administration of amiodarone to treat cardiac arrhythmias or the administration of interferon-alpha to treat viral diseases. Three multinuclear, giant cell granulomas observed in a fine-needle aspiration biopsy of the thyroid; from a patient with thyrotoxicosis from lymphocytic or subacute granulomatous thyroiditis. Diagnosis Laboratory test results vary (...) . . Mormile R. Celiac disease and Hashimoto's thyroiditis: a shared plot?. Int J Colorectal Dis . 2015 Aug 23. . Tomer Y, Dolan LM, Kahaly G, Divers J, D'Agostino RB Jr, et al. Genome wide identification of new genes and pathways in patients with both autoimmune thyroiditis and type 1 diabetes. J Autoimmun . 2015 Jun. 60:32-9. . Media Gallery Three multinuclear, giant cell granulomas observed in a fine-needle aspiration biopsy of the thyroid; from a patient with thyrotoxicosis from lymphocytic or subacute

2014 eMedicine Pediatrics

48. 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

2015 FP Notebook

49. Thyroid Disorders in Pregnancy

than nonpregnant women. Hashimoto thyroiditis Maternal immune suppression during pregnancy often ameliorates ; however, hypothyroidism or hyperthyroidism that requires treatment sometimes develops. Acute (subacute) thyroiditis Common during pregnancy, acute thyroiditis usually produces a tender goiter during or after a respiratory infection. Transient, symptomatic hyperthyroidism with elevated T4 can occur, often resulting in misdiagnosis as Graves disease. Usually, treatment is unnecessary (...) transient but may require treatment. After delivery, Graves disease may recur transiently or persistently. Painless thyroiditis with transient hyperthyroidism is a recently recognized postpartum, probably autoimmune disorder. It occurs abruptly in the first few weeks postpartum, results in a low radioactive iodine uptake, and is characterized by lymphocytic infiltration. Diagnosis is based on symptoms, thyroid function tests, and exclusion of other conditions. This disorder may persist, recur

2013 Merck Manual (19th Edition)

50. Recognition and Initial Management of Fulminant Myocarditis: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

, neutrophils, and macrophages. It can clinically present in subclinical, subacute, acute, and fulminant forms, and the trajectory of patients is highly variable, regardless of presentation. , , Prompt diagnosis is critical for management because the prognosis and likelihood of recovery are better with lymphocytic myocarditis than with nonspecific histological findings or GCM. Estimates of incidence vary widely because of the inherent biases in epidemiological reporting and challenges in establishing (...) and reducing the likelihood of exacerbating injury to the already inflamed heart. Although FM is too rare to have randomized controlled trials evaluating the use of temporary MCS devices to support the failing circulation, several case reports have described recovery once the circulation was fully supported and the patient’s end organs perfused, allowing time for the heart to recover. , In patients with fulminant lymphocytic myocarditis, the heart will often recover spontaneously with time, and in other

2020 American Heart Association

51. Rheumatoid arthritis

, polyarticular gout, connective tissue disease, or medical conditions such as sarcoidosis, thyroid disease, multiple myeloma, infective endocarditis, acute rheumatic fever 2013 2. Efficacy of wrist working splints in patients with rheumatoid arthritis : A randomized controlled study 19035420 2008 12 09 2009 01 27 2008 12 09 0004-3591 59 12 2008 Dec 15 Arthritis and rheumatism Arthritis Rheum. Efficacy of wrist working splints in patients with rheumatoid arthritis : a randomized controlled study. 1698-704 (...) in processing the XML document An error has occurred in processing the XML document An error occurred retrieving content to display 2016 11. Plaquenil (hydroxychloroquine sulfate) - Long-acting symptomatic treatment of rheumatoid arthritis , Discoid lupus erythematosus, Subacute lupus erythematosus, systemic lupus erythematosus, Prevention of polymorphous light eruption HAS - Medical, Economic and Public Health Assessment Division 1/11 The legally binding text is the original French version T TR RA AN NS SP

2018 Trip Latest and Greatest

54. Comprehensive Systematic Review Summary: Disease-modifying Therapies for Adults with Multiple Sclerosis

-related) costs are estimated to be $24,000 or more for people living with MS than for those without MS. e2 MS is considered an immune-mediated demyelinating disease of the CNS, characterized on histopathology by focal perivenular infiltrates of leukocytes (primarily macrophages and lymphocytes) and plaque formation. e3,e4 In acute plaques, oligodendroglial cells are injured, with relative axonal sparing, although many axons are also transected. In these plaques, macrophages stain positively for myelin

2018 American Academy of Neurology

55. Management of acute (fulminant) liver failure

was rede?ned to take into account the aetiology, frequency of complications and prognosis (Table 2) [4]. Considering jaundice as the ?rst symptom, hyperacute liver failure describes patients developing HE within 7days of noting jaundice. Acute liver failure occurs when patients develop HE between 8 and 28days of noting jaundice; and subacute liver failure describes HE occurring within 5–12weeks of jaundice (Fig. 1). Disease duration of greater than 28weeks before the onset of encephalopathy (...) is categorised as chronic liver disease. The International Association for the Study of the Liver (IASL) sub-committee statement (1999) de?ned hyperacute ALF as less than 10days, fulminant ALF as 10days to 30days and subacute hepatic failure as 5 to 24weeks [7]. Hyperacute presentations consist of severe coagulopathy, markedly increased serum transaminases and initially only moderate, if any, increase in bilirubin [8]. In contrast, subacute/subfulminant presentations often have a milder increase in serum

2017 European Association for the Study of the Liver

56. BSR guideline Management of Adults with Primary Sjögren's Syndrome Full Text available with Trip Pro

Standards, Guideline and Audit Working Group, The British Society for Rheumatology guideline for the management of adults with primary Sjögren’s Syndrome, Rheumatology , Volume 56, Issue 10, October 2017, Pages e24–e48, Download citation file: © 2019 Oxford University Press Navbar Search Filter Mobile Microsite Search Term Close search filter search input , , , Background Primary Sjogren's Syndrome (pSS) is a classic, immune-mediated, condition of unknown aetiology characterized by focal lymphocytic (...) infiltration of exocrine glands [ ]. Patients characteristically complain of drying of the eyes and mucosal surfaces along with fatigue and arthralgia. There is an association with autoimmune thyroid disease, coeliac disease and primary biliary cirrhosis. Systemic features include inflammatory arthritis, scLE, immune thrombocytopenia (ITP), vasculitis with purpura, salivary gland inflammation, neuropathies, interstitial lung disease (ILD) and a 5–10% lifetime risk of B cell lymphoma [ , ]. NICE has

2017 British Society for Rheumatology

57. Guideline for the management of adults with Systemic Lupus Erythematosus Full Text available with Trip Pro

[ ] Tacrolimus 1–3 mg/day (assess drug levels) Moderate/severe lupus, steroid-sparing 3 3 D 2 cohort studies [ , ]; 1 SR [ ] LEF (20 mg/day) Moderate lupus without subacute rash 3 3 D 1 small blind RCT [ ]; 1 cohort study [ ]; 1 SR [ ] CYC (see text for dosing) Severe lupus, including NPSLE, prevent flare, steroid-sparing 30 2 ++ B 4 open-label RCTs [ ]; 25 cohort studies covered by 1 SR [ ] Rituximab 1000 mg × 2 Refractory severe and moderate lupus; steroid-sparing 33 2+ C 1 blind RCT [ , ]; 3 open-label (...) case series [ ]; 2 SRs [ , ] Mycophenolic acid/sodium 1.44–2.16 g/day For patients intolerant of MMF 2 3 D 1 open-label RCT [ ]; 1 cohort study [ ] Ciclosporin ≤2.5 mg/kg/day Moderate/severe lupus including cytopenias, prevent flare, steroid-sparing 11 2+ C 2 open-label RCTs [ , ]; 8 cohort studies [ ]; 1 SR [ ] Tacrolimus 1–3 mg/day (assess drug levels) Moderate/severe lupus, steroid-sparing 3 3 D 2 cohort studies [ , ]; 1 SR [ ] LEF (20 mg/day) Moderate lupus without subacute rash 3 3 D 1 small

2017 British Society for Rheumatology

58. Childhood Hematopoietic Cell Transplantation (PDQ®): Health Professional Version

information). This approach to transplantation relies on GVL because, in most cases, the intensity of the preparative regimen is not sufficient for cure. Although studies have shown benefit for patients pursuing this approach when they are ineligible for standard transplantation,[ ] this approach has not been used for most children with cancer who require HCT because pediatric cancer patients can generally undergo myeloablative approaches safely. Using donor lymphocyte infusions (DLI) or early withdrawal (...) of immune suppression to enhance GVL GVL can be delivered therapeutically through the infusion of cells after transplant that either specifically or nonspecifically target the tumor. The most common approach is the use of DLI. This approach relies on the persistence of donor T-cell engraftment after transplant to prevent rejection of donor lymphocytes infused to induce the GVL. Therapeutic DLI results in potent responses in patients with CML who relapse after transplant (60%–80% enter into long-term

2018 PDQ - NCI's Comprehensive Cancer Database

59. HIV infection and AIDS

HIV infection and AIDS HIV infection and AIDS - NICE CKS Share HIV infection and AIDS: Summary The Human Immunodeficiency Virus (HIV) is a retrovirus that preferentially infects and destroys cells of the immune system, in particular the CD4 cells (a class of T lymphocyte, also known as T helper cells). There are 2 main types of HIV: HIV-1 (the predominant type in the UK) is highly virulent and is found worldwide. HIV-2 is found mainly in West Africa but has also been reported in Portugal (...) of symptoms [ ]. There are 2 main types of HIV — HIV-1 and HIV-2. HIV-1 is highly virulent and is found worldwide. HIV-2 is found mainly in West Africa but has also been reported in Portugal, France, and increasingly in India and South America [ ; ]. HIV causes immunodeficiency by preferentially infecting and destroying cells of the immune system, in particular the CD4 cells, a class of T lymphocytes which are also known as T helper cells [ ]. Natural history of HIV A flu-like illness is common

2018 NICE Clinical Knowledge Summaries

60. Hypothyroidism

iodine deficiency is the most common cause of hypothyroidism [ ; ; ; ]. Autoimmune thyroiditis (such as Hashimoto’s or atrophic thyroiditis) In areas where iodine occurs naturally at levels compatible with health, such as the UK, hypothyroidism is most often due to autoimmunity (destruction of thyroid follicular cells by lymphocytes) [ ; ; ; ; ]. Autoimmune thyroiditis may be associated with a goitre (Hashimoto's thyroiditis) or occur without a goitre (atrophic thyroiditis or primary myxoedema (...) [ ; ; ; ]. Transient thyroiditis Subacute (de Quervain's) thyroiditis — painful swelling of the thyroid gland thought to be caused by viral infection [ ; ]. Postpartum thyroiditis (PPT) — PPT is the development of thyrotoxicosis, hypothyroidism, or thyrotoxicosis followed by hypothyroidism within a year of giving birth, in women who were euthyroid prior to pregnancy [ ; ; ]. Thyroid infiltrative disorders These include amyloidosis, sarcoidosis, haemochromatosis, tuberculosis, and scleroderma [ ]. Congenital

2018 NICE Clinical Knowledge Summaries

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