Thyroiditis比較表
|
Type |
Acute thyroiditis (Suppurative thyroiditis) |
Subacute thyroiditis (de Quervain’s) |
Hashimoto’s thyroiditis |
Riedel’s thyroiditis |
|
Etiology |
Bacteria>other pathogen |
Virus? |
Autoimmune |
Unknown |
|
Clinical finding |
acutely ill with fever, dysphagia, dysphonia, anterior neck pain and erythema, and a tender thyroid mass |
preceding URI, fever and severe neck pain, swelling, thyrotoxicosis syndrome |
Usually hypothyrodisim; painless; +/-goiter |
rock-hard, fixed, painless goiter, esophageal compression or hypoparathyroidism |
|
Age at onset(yr) |
Children, 20-40 |
20-60 |
All ages, peak 30-50 |
30-60 |
|
ESR |
High |
High |
Normal |
Normal |
|
Thyroid |
Usually euthyroidism |
Early thyrotoxicosis, then hypothyroidism |
Hypothyroidism |
Usually euthyroidism |
|
24-hr 123I uptake |
Cold lesion |
Low RAI uptake |
Variable |
Low or normal |
|
Pathological findings |
Abscess formation |
Giant cells, granulomas |
Lymphocytic infiltration, germinal centers, fibrosis |
Dense fibrosis |
參考Harrison, NEJM 2003;Thyroiditis, First Aid for the internal medicine
|
Suppurative thyroiditis (rare in modern time) |
||
|
Etiology |
usually caused by bacterial infection, others: fungal, mycobacterial, or parasitic infections |
|
|
S/S |
usually acutely ill with fever, dysphagia, dysphonia, anterior neck pain and erythema, and a tender thyroid mass. Symptoms may be preceded by an acute upper respiratory infection. |
|
|
Lab |
thyroid function generally normal, but both thyrotoxicosis and hypothyroidism have been reported. WBC and ESR are elevated |
|
|
RAIU |
No uptake; suppurative area show "cold" lesion |
|
|
Diagnosis |
FNA with Gram's staining and culture is the diagnostic test of choice |
|
|
Treatment |
Drainage and antibiotics |
|
|
Painful subacute thyroiditis (self-limited , the most common cause of thyroid pain) |
||
|
Etiology |
incidence is highest in summer, correlating with the peak incidence of enterovirus. |
|
|
S/S |
prodrome of generalized myalgias, pharyngitis, low-grade fever, and fatigue.(preceding URI) |
|
|
fever and severe neck pain, swelling, or both. |
||
|
Up to 50 percent of patients have symptoms of thyrotoxicosis. Most pt thyroid function will be normal after several weeks of thyrotoxicosis, and hypothyroidism will subsequently develop, lasting four to six months. |
||
|
Thyroid echo |
the gland is hypoechogenic and has low-to-normal vascularity. |
|
|
Lab |
markedly elevated ESR; WBC mildly increase; serum T4 elevateànormalàdecrease |
|
|
RAIU |
The 24-hour 123I uptake is low (<5 percent) in the toxic phase of subacute thyroiditis |
|
|
Treatment |
NSAID, glucocorticoid, acetaminophen, βblocker for thyrotoxicosis |
|
討論:
該病人主訴為left anterior neck pain for 3 months, 觸診neck的部分, 以bilateral thyroid region tenderness表現, major differential diagnosis 以painful subacute thyroiditis or acute suppurative thyroiditis;
|
Characteristic |
Acute Thyroiditis |
Subacute Thyroiditis |
病人表現 |
|
|
History |
Preceding URI |
88% |
17% |
10 d ago |
|
Fever |
100% |
54% |
Denied |
|
|
Symptoms of thyrotoxicosis |
Uncommon |
47% |
Denied |
|
|
Sore throat |
90% |
36% |
Denied |
|
|
PE |
Painful thyroid swelling |
100% |
77% |
Yes |
|
Left side affected |
85% |
not specific |
Yes |
|
|
Migrating thyroid tenderness |
Possible |
27% |
Unknown |
|
|
Erythema of overlying skin |
83% |
not usually |
No |
|
|
Laboratory |
Elevated white blood cell count |
57% |
25-50% |
No |
|
Elevated ESR(>30mm/hr) |
100% |
85% |
待驗 |
|
|
Abnormal thyroid hormone levels(↑↓) |
5-10% |
60% |
No |
|
|
Alkaline phosphatase, transaminases(↑) |
Rare |
common |
未驗 |
|
|
Needle Aspiration |
Purulent, bacteria or fungi present |
~100% |
0 |
|
|
Lymphocytes, macrophages, some polys, giant cells |
0 |
~100% |
|
|
|
123I uptake low |
Uncommon |
~100% |
|
|
|
Radiological |
Abnormal thyroid scan |
92% |
— |
|
|
Thyroid scan or ultrasound helpful in diagnosis |
75% |
— |
|
|
|
Gallium scan positive |
~100% |
~100% |
|
|
|
Barium swallow showing fistula |
Common |
0 |
|
|
|
CT scan useful |
Rarely |
not indicated |
|
|
|
Clinical Course |
Clinical response to glucocorticoid treatment |
Transient |
100% |
|
|
Incision and drainage required |
85% |
No |
|
|
|
Recurrence following operative drainage |
16% |
No |
|
|
Szabo SM, Allen DB. Thyroiditis. Differentiation of acute suppurative and subacute. Case report and review of the literature. Clin Pediatr
