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).
D. Misdiagnosis and diagnosis
D.1. Misdiagnosis
There is a report of silent thyroiditis misdiagoesd as Malignant lymphoma of the thyroid.
It was difficult to make differential diagnosis of this case from
malignant lymphoma of the thyroid clinically and cytologically when
immune rebound phenomena with invasion of lymphocyte and appearance of
lymph follicle were the strongest. There is a report of a case of a
30-year-old female with postpartum silent thyroiditis misapprehended as
malignant lymphoma of the thyroid(36).
D.2. Diagnosis
After recording the past and present history and completing a physical
exam, including assessing symptoms and complaints commonly seen
including enlarged thyroid gland, heart rate, shaking hand etc. The
tests which your doctor orders may include
1. Radioactive iodine uptake test, or RAIU test
In the study to investigate the effects of iodine restriction on the
RAIU value, and the necessity of iodine restriction in differentiating
between Graves’ disease (GD) and silent thyroiditis (ST) of 415
patients, 277 of whom were patients with GD who had undergone iodine
restriction before RAIU [GD(+)], 66 were patients with GD who did not
undergo iodine restriction [GD(-)], 61 were patients with ST who had
undergone iodine restriction [ST(+)], and the remaining 11 were patients
with ST who did not undergo iodine restriction [ST(-)], indicated that
high diagnostic value of the RAIU test was confirmed, but not affected
by the presence of iodine restriction in the differentiation between GD
and ST, therefore, iodine restriction before the RAIU test was
unnecessary(37).
2. Blood test for blood levels of the thyroid hormones T3 and T4
The aim of the test is to the level of free T4 and thyroid stimulating
hormone (TSH) levels. Circulating analytes used in the exploration of
thyroid function are TSH and free thyroid hormones (FT4 and FT3). TSH is
used as first line analysis in diagnosis because a normal value
excludes almost always a thyroid dysfunction(38).
3. Thyroid scintigraphy
Thyroid scintigraphy with 99mTc allows establishing the functional
characteristics of thyroid nodules (warm or cold) and to precise the
origin of a thyrotoxicosis (autonomous toxic nodule vs Graves-Basedow,
sub acute or silent thyroiditis(39).
4. Thyroid biopsy
In the study of usefulness of thyroid needle biopsy in the differential
diagnosis of thyroid disorders revealing unusual thyroid function, in
601 cases of chronic thyroiditis. indicated that group A, the majority
of the cases showed a latent or overt hypothyroidism and in histologic
group B, hyperthyroid, euthyroid and latent hypothyroid cases were found
in nearly equal frequency, respectively. In histologic group C, most
cases were in euthyroid and in histologic group D, most cases showed a
hyperthyroidism. In the silent thyroiditis and postpartum thyroiditis,
known to show a characteristic clinical and laboratory finding, the
histologic features of thyroid gland were as follows: the observed
characteristic histologic changes in both diseases were an extensive
follicular destruction associated with chronic diffuse thyroiditis(40).
Chinese Secrets To Fatty Liver And Obesity Reversal
Use The Revolutionary Findings To Achieve
Optimal Health And Loose Weight
Back to General health http://kylejnorton.blogspot.ca/p/general-health.html
Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca
Sources
(a) http://www.ncbi.nlm.nih.gov/pubmed/22443972
(36) http://www.ncbi.nlm.nih.gov/pubmed/8341248
(37) http://www.ncbi.nlm.nih.gov/pubmed/15307943
(38) http://www.ncbi.nlm.nih.gov/pubmed/23091928
(39) http://www.ncbi.nlm.nih.gov/pubmed/23091928
(40) http://www.ncbi.nlm.nih.gov/pubmed/1942566
No comments:
Post a Comment