The immune system attacks the thyroid gland in certain infections and other conditions resulting in stress. Damage to the thyroid cells as a result of this attack is called thyroiditis. Briefly, thyroiditis is a disease that causes inflammation of the thyroid gland.

Acute thyroiditis:

The condition develops secondary to inflammation of the thyroid gland; it is also called suppurative or septic thyroiditis. Normally, the thyroid gland is resistant against infections since it is preserved inside a solid capsule/sheath and contains iodine in high concentrations. Rarely, infections of surrounding organs and tissues may spread to the thyroid gland, if the immune system is weak. Pain, tenderness and warmth may occur at the location of the thyroid gland. Fever and enlargement of the regional lymph nodes are detected. An ultrasound will show abscess in the thyroid gland. When the abscess is drained, both the diagnosis is verified and the condition is treated in most cases. Antibiotherapy is effective as well. If damage to the thyroid gland is severe and irreversible, hypothyroidism (underactive thyroid) may occur. Hormone therapy is started when hypothyroidism is diagnosed. 

Subacute thyroiditis (Granulomatous thyroiditis / DeQuervain thyroiditis)

The condition mostly occurs as a result of upper respiratory tract infection caused by viruses and it is confined to the thyroid gland. Sometimes, certain substances that are secreted by the body and related with the immune system may also lead to subacute thyroiditis. Those patients usually have history of upper respiratory tract infection 2 to 8 weeks before symptoms of this type of thyroiditis emerge. Although the underlying cause of this condition is not clearly known, it is considered that the immune system perceives the thyroid gland as a foreign structure and attacks the gland following the infection. The prevalence increases at the age of 40 to 50 and it is 3-4 folds higher in women than men.  Complaints include pain in the neck – also radiates to the ear - resulting in difficulty swallowing. The pain may be located at either side of the neck and palpation worsens the tenderness. Moreover, fatigue, tiredness, pain in joint and muscle, mild fever and cold are likely. Symptoms of palpitation, sweating, bad temper, hair loss and diarrhea may develop secondary to hormones that are secreted into the bloodstream from the damaged segment of the thyroid gland. Course of the disease is slow and may last 6-8 weeks. After the hormones in the bloodstream decreases, the complaints regress. Minimal thyroid hormone deficiency (hypothyroidism) may occur in half of the patients and dry skin, absence, periorbital swelling, cold intolerance and constipation may be observed. There is the risk of permanent hypothyroidism in one out of every ten patients after treatment is completed. 

As thyroid hormones regulate metabolic functions, subacute thyroiditis causes impairment of the metabolic order. At the initial stage, the thyroid hormones that are fragmented due to infection enter the bloodstream, resulting in hypermetabolism. This condition is called hyperthyroidism; as a result, the patient experiences sudden weight loss, sweating, palpitation and shortness of breath. Hormones are restored to normal ranges and the metabolism is regulated within the next two weeks. However, when the disease progresses, hypothyroidism emerges and weight gain, dry skin, somnolence and constipation occur. When the disease disappears, the thyroid gland and metabolism start functioning properly. However, it should be remembered that irreversible hypothyroidism is likely in one out of every ten patients. 

Simple painkillers may be helpful for mild cases. Corticosteroid, namely cortisone therapy, may be started for more severe cases. Typically, the disease persists for 8-10 weeks. In case the disease relapses frequently despite the treatments, surgical excision of the thyroid gland can be considered, but this procedure is employed very rarely. One should always remember that resting is very crucial in the course of the treatment. As treatments are not able to prevent hypothyroidism in some patients, regular follow-up is required. It is recommended to reduce salt and sugar consumption during corticosteroid therapy. It is not necessary to restrict the foods that contain iodine, unless otherwise is instructed by your doctor.

Hashimoto’s Thyroiditis (Chronic Autoimmune Thyroiditis)

The incidence of Hashimoto’s Thyroiditis is very high among thyroid disorders. Incidence of the condition is one out of every 1 thousand patients and 20 folds higher in women than men. Mostly, the disease occurs in women aged 20 and 50. When the immune system perceives the thyroid gland as a foreign structure and immune cells attack the thyroid gland, Hashimoto’s Thyroiditis develops.

At the initial stage, the disease is characterized by enlargement of the thyroid gland (goiter) followed by gradual reduction. There is risk of other immune- related diseases in patients with Hashimoto’s Thyroiditis .
Common symptoms of Hashimoto disease, including palpitation, sweating and restlessness with no exact cause, are usually ignored. The disease is noticed remarkably, when thyroid hormone deficiency develops rapidly and intensely. Mostly, the disease impairs thyroid functions slowly and insidiously, resulting in loss of functions. If hypothyroidism is obvious on blood tests, this means the disease is irreversible.

Follow-up and treatment are guided by disease-specific antibodies. If these antibodies are high, but readings of thyroid hormones are within normal ranges, no treatment is required. Although it is known that selenium plays a role in declining level of antibodies, it does not help prevention of hypothyroidism. In other words, it does not change course of the disease. Thus, continuous selenium supplementation is not recommended. If there is a pregnancy plan, patient-specific approaches are adopted in follow-up and treatment. If hypothyroidism is detected, hormone replacement therapy is started.