Medical Conditions | Uncategorized

Thyroiditis

Inflammation of the thyroid gland, which can be caused by infection; more commonly it is an autoimmune disease involving antibodies against thyroid tissue. A few days or weeks after infection of the air passages (usually by a virus) the thyroid swells increasingly and painfully, and swallowing becomes more difficult. Pain usually radiates to the jaw and ears (de Quervain’s thyroiditis). Treatment is by large doses of aspirin and sometimes corticosteroids. Chronic thyroiditis (Hashimoto’s disease) is the commonest form; it is an autoimmune condition with no known cause that occurs mainly in women, often associated with little pain, simply enlargement of the thyroid (goitre). After several months most of the normal thyroid tissue is replaced with connective tissue. Treatment with thyroid hormones helps in allowing the gland to return to its normal size. In the early stages of any form of thyroiditis it is possible that excess thyroid hormones will be produced; in the chronic form the gland can sometimes not produce sufficient hormones, in which case continuing hormone treatment is essential. Sometimes the thyroid swells to such an extent that swallowing or breathing is restricted, in which case surgery is necessary to reduce pressure on the oesophagus or windpipe. May be either benign or malignant, and for this reason any lump at the front of the neck should be examined very thoroughly. Lumps in the thyroid occur quite frequently; there may be only one, or the whole gland can be full of them, in the latter case often as a result of persistent goitre. Benign and malignant tumours are more common in women than men. A benign tumour of the thyroid is usually soft, painless and grows slowly, over many years. It consists of normal thyroid tissue, and produces thyroid hormones, but their production cannot be controlled by the pituitary gland. As the tumour grows, so hormone production can increase; the remaining thyroid tissue does not have to produce hormones, control is increasingly lost, and hyperthyroidism symptoms occur. A malignant tumour generally produces few or no hormones. These qualities make it possible to establish the nature of the tumour by a relatively simple test (thyroid scintography). Slightly radioactive iodine is injected into a vein; the iodine accumulates in the thyroid, and it is then possible by radiation measurement to establish in which part of the thyroid the iodine is present, and whether it has been absorbed by the tumour. If it has, the tumour also shows radiation, thus suggesting that it is probably benign, because it is producing hormones; if no iodine has been absorbed by the tumour and no radiation is present, then it is probably malignant. There are other means by which the nature of the tumour can be diagnosed, such as sonography to establish the presence of a cyst, a fluid-filled cavity that is usually benign. Treatment is not always necessary in the case of small, slow-growing benign tumours, but they should be checked regularly. Treatment of larger benign thyroid tumours can be by injection of radioactive iodine; the level of radioactivity is such that hormone production in a large number of cells is checked. Another treatment is surgery to remove the lumps. After this thryoid hormones have to be administered for a long period because the thyroid tissue has been inactive for so long. Cancer of the thyroid is treated by complete removal of the gland, often in combination with radiation therapy on the neck. In some cases it is possible to treat tumours formed elsewhere in the body by metastasis with radioactive iodine. Once the thyroid has been removed, artificial thyroid hormones need to be taken for the rest of the patient’s life. A possible complication of such surgery is that the laryngitic nerve can be damaged, sometimes severely hindering normal speech. Generally speaking the chances of recovery after treatment for thyroid cancer are high.

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