Tireoidit – inflammatory damage of a thyroid gland of sharp, subsharp, chronic, autoimmune character. It is shown by pressure sense, painful feelings in a neck, swallowing difficulty, a voice osiplost. At acute inflammations formation of abscess is possible. Progressing of a disease causes diffusion changes in iron and violation of its functions: in the beginning the phenomena of a gipertireoz, and subsequently – a hypothyroidism, demanding the corresponding treatment. Depending on clinical features and a current allocate sharp, subsharp and chronic tireoidit; on an etiology - autoimmune, syphilitic, tubercular, etc.
Tireoidit – inflammatory damage of a thyroid gland of sharp, subsharp, chronic, autoimmune character. It is shown by pressure sense, painful feelings in a neck, swallowing difficulty, a voice osiplost. At acute inflammations formation of abscess is possible. Progressing of a disease causes diffusion changes in iron and violation of its functions: in the beginning the phenomena of a gipertireoz, and subsequently – a hypothyroidism, demanding the corresponding treatment.
Various mechanism and the causes can be the cornerstone of tireoidit, but all group of diseases is united by presence of the inflammatory component striking tireoidny fabric.
Classification of tireoidit
In the practice the clinical endocrinology uses the classification of tireoidit based on features of the mechanism of their development and clinical manifestation. Distinguish the following forms of a current of tireoidit: sharp, subsharp and chronic. Sharp tireoidit can extend to the whole share or all thyroid gland (diffusion) or proceed with partial defeat of a share of gland (focal). Besides, the inflammation at a sharp tireoidit can be purulent or not purulent.
Subsharp tireoidit meets in three clinical forms: granulematozny, pnevmotsistny and limfitsitarny tireoidit; on prevalence happens focal and diffusion. The group of chronic tireoidit is presented by an autoimmune tireoidit of Hashimoto, a fibrous and invasive craw of Ridel and specific tireoidita of a tubercular, syphilitic, septomikozny etiology. The purulent form of a sharp tireoidit and a chronic fibrous and invasive craw of Ridel are observed exclusively seldom.
Reasons of tireoidit
Development of a sharp purulent tireoidit happens after the postponed sharp or chronic infectious diseases – tonsillitis, pneumonia, sepsis, etc. as a result of a hematogenic drift of their activators in tissue of a thyroid gland. The sharp not purulent form of a tireoidit can develop as a result of traumatic, beam injury of a thyroid gland, and also after hemorrhages in its fabrics.
Is the cornerstone of a subsharp (granulematozny) tireoidit of de Querven virus damage of cells of a thyroid gland by causative agents of various infections: adenoviruses, viruses of measles, flu, epidemic parotitis. The disease 5-6 times more often develops at women, mainly between 20 and 50 years, is clinically shown several weeks later or months after an outcome of a viral infection. Flashes of a tireoidit of de Querven are connected with the periods of the greatest virus activity. Subsharp tireoidit develops 10 times less often than autoimmune and is followed by reversible, passing dysfunction of a thyroid gland. Chronic infections of a nasopharynx and genetic hereditary factors contribute to development of a subsharp current of a tireoidit.
At a fibrous tireoidit (Ridel's craw) considerable growth of connecting fabric in a thyroid gland and a sdavleniye of structures of a neck is observed. Development of a craw of Ridel meets among women more often 40-50 years are more senior. The etiology of a fibrous tireoidit is finally not found out: a certain role of infections in its development is supposed, a part of researchers are inclined to consider Ridel's craw the result of autoimmune damage of a thyroid gland at Hashimoto's tireoidita. The patients who had a thyrotoxicosis, the thyroid gland operations having an endemic craw, genetic predisposition, and also having autoimmune and allergic diseases, diabetes are inclined to development of a fibrous tireoidit.
Symptoms of tireoidit
At a purulent form of a sharp tireoidit inflammatory infiltration of a thyroid gland with the subsequent formation of an abscess (abscess) in it is observed. The zone of purulent fusion is switched off from sekretorny activity, however more often it takes an insignificant part of fabric of gland and does not cause sharp violations of hormonal secretion.
Purulent tireoidit develops sharply - from high temperature (to 40 °C) and a fever. Sharp pains on the forward surface of a neck with shift in the nape, jaws, language, ears amplifying at cough, swallowing and the movements of the head are noted. Promptly intoxication accrues: there is an expressed weakness, weakness, an ache in muscles and joints, the headache, accrues tachycardia. Quite often the condition of the patient is estimated as heavy.
Palpatorno is defined local or diffusion increase in a thyroid gland, sharp morbidity, dense (on stages of an infiltrative inflammation) or softened (at a stage of purulent fusion and formation of abscess) a consistence. Neck skin hyperaemia, local temperature increase, increase and morbidity of cervical lymph nodes is noted. Not purulent form of a sharp tireoidit is characterized by an aseptic inflammation of tireoidny fabric and proceeds with less expressed symptomatology.
The current of a subsharp tireoidit can have pronounced signs of an inflammation: febrilny body temperature (38 °C and above), pains in the field of the forward surface of a neck with irradiation in jaws, a nape, an ear, weakness, increase of intoxication. However development of a disease is more often happens gradual and begins with an indisposition, discomfort, moderate morbidity and a swelling in a thyroid gland, especially during the swallowing, inclinations and turns of the head. Pains amplify when chewing firm food. At a palpation of a thyroid gland increase and morbidity of one of its shares usually comes to light. The next lymph nodes are not increased.
Subsharp tireoidit at a half of patients is followed by development of a thyrotoxicosis of easy or average degree of expressiveness. Complaints of patients are connected with perspiration, heartbeat, a tremor, weakness, sleeplessness, nervousness, intolerance of a heat, joint pains.
The excess amount of the tireoidny hormones emitted by gland (a tiroksina and a triyodtironina) has the braking effect on a hypothalamus and reduces production of hormone regulator of a tirotropin. In the conditions of deficiency of a tirotropin there is a decrease in function of not changed part of a thyroid gland and development of a hypothyroidism in the second phase of a subsharp tireoidit. The hypothyroidism usually does not happen long and expressed, and with attenuation of an inflammation the level of tireoidny hormones returns to normal.
Thyrotoxicosis stage duration (sharp, initial) at a subsharp tireoidit makes from 4 to 8 weeks. During this period morbidity of a thyroid gland and neck, decrease in accumulation are noted by gland of radioactive iodine, the thyrotoxicosis phenomenon. In a sharp stage there is exhaustion of reserves of tireoidny hormones. In process of reduction of receipt the stage of an eutireoz which is characterized by the normal level of tireoidny hormones develops in blood of hormones.
In cases of a heavy current of a tireoidit at the expressed decrease in quantity of the functioning tirotsit and exhaustion of a reserve of hormones of a thyroid gland the hypothyroidism stage with its kliniko-biochemical manifestations can develop. Finishes a current of a subsharp tireoidit a recovery stage during which there is finally a restoration of structure and sekretorny function of a thyroid gland. Development of a resistant hypothyroidism is noted seldom, practically at all patients who transferred subsharp tireoidit, function of a thyroid gland is normalized ().
Chronic fibrous tireoidit
The current of a chronic fibrous tireoidit long time can not cause violations of health at slow, gradual progressing of structural changes of tireoidny fabric. As the earliest manifestation of a fibrous tireoidit serves difficulty of swallowing and feeling of "a lump in a throat". In the developed stage of a disease violations of breath, swallowing, the speech, hoarseness of a voice, a poperkhivaniye develop during food.
Palpatorno is defined significant uneven increase in a thyroid gland (bugristost), its consolidation, low-mobility when swallowing, a dense "ligneous" consistence, painlessness. Defeat of gland has, as a rule, diffusion character and is followed by decrease in its functional activity with development of a hypothyroidism.
Sdavleniye of the next structures of a neck causes the compression syndrome which is shown a headache, sight violations, noise in ears, difficulties at the act of swallowing, a pulsation of cervical vessels, breath violation.
Inflammatory and structural changes of tireoidny tissue of thyroid gland at its tubercular, syphilitic, mycotic defeat belong to specific tireoidita. Specific tireoidita carry a chronic current; in cases of accession of a secondary infection gain acuity.
Complications of tireoidit
The purulent inflammation of a thyroid gland at a sharp tireoidit proceeding with formation of abscess is fraught with opening of a purulent cavity in surrounding fabrics: a sredosteniye (with development of a mediastinit), a trachea (with development of aspiration pneumonia, lung abscess). Distribution of purulent process on tissue of a neck can cause development of phlegmon of a neck, damage of vessels, hematogenic spread of an infection on brain covers (meningitis) and tissues of a brain (encephalitis), development of sepsis.
Neglect of a tireoidit of a subsharp current causes damage of a significant amount of tireotsit and development of irreversible insufficiency of a thyroid gland.
Diagnostics of tireoidit
At all forms of tireoidit of change in the general blood test are characterized by inflammation signs: neytrofilny leykotsitoz, shift of a leykotsitarny formula to the left, increase in SOE. The sharp form of a tireoidit is not followed by change of level of tireoidny hormones in blood. At a subsharp current increase in concentration of hormones (a thyrotoxicosis stage) is noted in the beginning, then there is their decrease (, a hypothyroidism). At ultrasonography of a thyroid gland its focal or diffusion increase, abscesses, knots comes to light.
Carrying out a stsintigrafiya of a thyroid gland specifies the size and character of the center of defeat. In a hypothyroidism stage at a subsharp tireoidit decrease in absorption by a thyroid gland of radioisotopes of iodine (less than 1% is noted, at norm of 15 - 20%); in a stage of an eutireoz with restoration of function of tireotsit accumulation of radioactive iodine is normalized, and in view of increase in activity of the regenerating follicles temporarily increases in a recovery stage. Stsintigrafiya at a fibrous tireoidit allows to find the sizes, indistinct contours, the changed shape of a thyroid gland.
Treatment of tireoidit
At easy forms of tireoidit it is possible to be limited to observation of the endocrinologist, purpose of nonsteroid anti-inflammatory medicines for knocking over of a pain syndrome, symptomatic therapy. At the expressed diffusion inflammation apply steroid hormones (Prednisolonum with gradual decrease in a dose).
At a sharp purulent tireoidit hospitalization of the patient is carried out to office of surgery. Active antibacterial therapy (penicillin, tsefalosporina), vitamins B and With, antihistaminic medicines (, , , ), massive intravenous dezintoksikatsionny therapy is appointed (salt solutions, ). When forming abscess in a thyroid gland surgical opening and drainage is carried out it.
Treatment of a subsharp and chronic tireoidit is carried out by hormones of a thyroid gland. At development of a compression syndrome with signs of a sdavleniye of structures of a neck resort to surgery. Specific tireoidita recover performing therapy of the main disease.
Forecast and prevention of tireoidit
Early treatment of a sharp tireoidit comes to an end with an absolute recovery of the patient in 1,5-2 months. Seldom after the postponed purulent tireoidit the resistant hypothyroidism can develop. Active therapy of a subsharp tireoidit allows to achieve treatment in 2-3 months. The started subsharp forms can proceed up to 2 years and accept chronic character. Long-term progressing and development of a hypothyroidism is characteristic of a fibrous tireoidit.
For the prevention of a tireoidit the role of prevention of infectious and viral diseases is big: hardening, vitamin therapy, healthy food and way of life. Carrying out timely sanitation of the chronic centers of an infection is necessary: treatment of caries, otitis, tonsillitis, antritis, pneumonia etc. Implementation of medical recommendations and appointments, prevention of independent decrease in a dose of hormones or their cancellation will allow to avoid a recurrence of a subsharp tireoidit.