QuÉ es la glandula tiroides?

La glandula tiroides tiene forma de mariposa y normalmente se localiza en la parte de adelante del cuello, su trabajo es formar las hormonas tiroideas, volcarlas al torrente sanguineo y entregarla a todos los tejidos del cuerpo.

Las hormonas tiroideas ayudan al cuerpo a utilizar energia, mantener la temperatura corporal y a que el cerebro, el corazon, los musculos y otros organos funcionen normalmente.

¿QuÉ es la tiroiditis?

Tiroiditis es un término general que se refiere a la "inflamación de la glándula tiroides". La tiroiditis incluye un grupo de trastornos individuales todos los cuales causan inflamación de la tiroides y como resultado producen distintas presentaciones clínicas. Por ejemplo, la tiroiditis de Hashimoto es la causa más común de hipotiroidismo en los Estados Unidos. La tiroiditis del post-parto, que causa una tirotoxicosis transitoria (niveles altos de hormona tiroidea en la sangre), seguida de hipotiroidismo transitorio, es una causa común de problemas de la tiroides después del parto. La tiroiditis subaguda es la causa principal de dolor en la tiroides. La tiroiditis también puede ocurrir en pacientes que toman los medicamentos interferón y amiodarona.

¿CuÁles son los síntomas clínicos de la tiroiditis?

No hay ningún síntoma que sea exclusivo de la tiroiditis. Si la tiroiditis causa daño y destrucción lenta y crónica de las células tiroideas, resultando en una caída en los niveles de hormona tiroidea en la sangre, los síntomas resultantes serán los del hipotiroidismo (ver el folleto de Hipotiroidismo). Los síntomas típicos del hipotiroidismo incluyen fatiga, aumento de peso, estreñimiento, piel seca, depresión y poca tolerancia al ejercicio. Este sería el caso de los pacientes con tiroiditis de Hashimoto. Si la tiroiditis causa daño y destrucción rápida de las células tiroideas, la hormona tiroidea que normalmente se encuentra almacenada en la glándula se escapa aumentando los niveles de hormona tiroidea en la sangre, produciendo síntomas de tirotoxicosis, que son similares al hipertiroidismo (Ver el folleto de Hipertiroidismo). Estos síntomas con frecuencia incluyen ansiedad, insomnio, palpitaciones (frecuencia cardíaca rápida), fatiga, pérdida de peso e irritabilidad. Esto se ve en los pacientes con la fase tóxica de la tiroiditis subaguda no dolorosa, y la tiroiditis del post-parto. Los síntomas de tirotoxicosis e hipertiroidismo son idénticos, ya que ambas afecciones son el resultado de niveles altos de hormona tiroidea en la sangre. En el caso de la tiroiditis, se utiliza el término tirotoxicosis, ya que la glándula no está hiperactiva. En la tiroiditis subaguda no dolorosa y la tiroiditis del post-parto, la glándula tiroides con frecuencia queda sin hormona tiroidea a medida que la inflamación continúa, lo cual conduce a una caída en los niveles de hormona tiroidea en la sangre y a los síntomas de hipotiroidismo. Dolor en la tiroides puede verse en pacientes con tiroiditis subaguda.

TIPOS

¿CuÁles son los tipos de tiroiditis?

Existen muchos tipos de tiroiditis, los cuales están resumidos en la siguiente tabla:

¿CuÁl es la causa de la tiroiditis?

La tiroiditis es causada por un ataque a la tiroides, que causa inflamación y daño de las células tiroideas. La mayoría de los casos de tiroiditis son causados por anticuerpos contra la tiroides. Como tal, la tiroiditis es con frecuencia una enfermedad autoimmune, como la diabetes juvenil y la artritis reumatoidea. Nadie sabe el por qué algunas personas producen anticuerpos contra la tiroides, aunque esto tiende a suceder en familias.

La tiroiditis también puede ser causada por una infección, tal como un virus o bacteria, que funciona igual que los anticuerpos causando inflamación de la glándula. Finalmente, drogas como el interferón y la amiodarona, pueden también producir daño a las células tiroideas y causar tiroiditis.

¿CuÁl es la evoluciÓn clÍnica de la tiroiditis?

La evolución de la tiroiditis depende del tipo de tiroiditis.

Tiroiditis de Hashimoto – Estos pacientes se presentan con hipotiroidismo, el cual generalmente es permanente.

Tiroiditis no dolorosa y tiroiditis del post-parto – Estos trastornos son similares y siguen el mismo curso clínico de la tirotoxicosis seguida de hipotiroidismo. La única diferencia real entre ambas es que la tiroiditis del posparto ocurre después del nacimiento de un bebé mientras que la tiroiditis no dolorosa sucede en hombres y mujeres sin relación con el embarazo. No todos los pacientes demuestran evidencia de pasar por ambas fases; aproximadamente 1/3 de los pacientes manifestarán ambas fases mientras que 1/3 de los pacientes mostrarán solamente la fase tirotóxica o hipotiroidea. La fase tirotóxica dura de 1 a 3 meses y se asocia con síntomas generales de ansiedad, insomnio, palpitaciones (frecuencia cardíaca alta), fatiga, pérdida de peso e irritabilidad, La fase hipotiroidea típicamente ocurre de 1 a 3 meses después de la fase tirotóxica y puede durar hasta 9 a 12 meses. Los síntomas típicos incluyen fatiga, aumento de peso, estreñimiento, piel seca, depresión y poca tolerancia al ejercicio. La mayoría de los pacientes (~80%) recuperarán su función tiroidea normal dentro de 12-18 meses de la aparición de los síntomas.

Tiroiditis subaguda – La tiroiditis subaguda sigue el mismo curso clínico que la tiroiditis no dolorosa y la tiroiditis del post-parto, con la excepción de los síntomas de dolor de la tiroides. El dolor tiroideo en pacientes con tiroiditis subaguda generalmente sigue el mismo curso temporal de la fase tirotóxica (1 a 3 meses). Sin embargo, no todos los pacientes con dolor tiroideo necesariamente tendrán tirotoxicosis. Como se mencionó con la tiroiditis no dolorosa y la tiroiditis del post-parto, en la mayoría de los pacientes (~95%) todas las anormalidades tiroideas se resolverán en 12 a 18 meses. La recurrencia de la tiroiditis subaguda es rara.

Tiroiditis inducida por drogas y radiaciÓn – Tanto la tirotoxicosis como el hipotiroidismo pueden verse en ambos trastornos. La tirotoxicosis usualmente es de corta duración. El hipotiroidismo inducido por drogas generalmente se resuelve al descontinuar la droga, mientras que el hipotiroidismo relacionado con la tiroiditis por radiación es generalmente permanente.

Tiroiditis aguda/ infecciosa – Los síntomas varían desde el dolor tiroideo, enfermedad sistémica, aumento de tamaño no doloroso de la tiroides e hipotiroidismo. Los síntomas generalmente desaparecen al resolverse la infección

¿CÓmo se trata la tiroiditis?

El tratamiento depende del tipo de tiroiditis y de la presentación clínica.

Tirotoxicosis – Los beta-bloqueantes pueden ser útiles para reducir las palpitaciones y el temblor. A medida que los síntomas mejoran, el medicamento se va reduciendo gradualmente hasta descontinuarlo, ya que la fase tirotóxica es transitoria. Los medicamentos anti-tiroideos (véase folleto Hipertiroidismo) no se utilizan para la fase tirotóxica de la tiroiditis de cualquier tipo, ya que la tiroides no está hiperactiva.

Hipotiroidismo – En el hipotiroidismo debido a la tiroiditis de Hashimoto se inicia tratamiento de substitución de hormona tiroidea (véase el folleto de Tratamiento con hormona tiroidea). En los pacientes sintomáticos que están en la fase hipotiroidea de la tiroiditis subaguda no dolorosa y del post-parto, el reemplazo de la hormona tiroidea también está indicado. Si el hipotiroidismo causado por estos últimos trastornos es leve y el paciente tiene pocos o ningún síntoma, entonces puede ser que no se necesite tratamiento alguno. Si se decide comenzar tratamiento con hormona tiroidea en pacientes con tiroiditis subaguda, no dolorosa y del post-parto, entonces dicho tratamiento deberá continuarse por aproximadamente 6- 12 meses y luego se reducirá la dosis gradualmente para deterrminar si se necesita hormona tiroidea en forma permanente.

Dolor tiroideo – El dolor asociado con la tiroiditis subaguda generalmente puede ser manejado con medicamentos anti-inflamatorios como la aspirina o el ibuprofeno. Ocasionalmente el dolor puede ser severo y requerir tratamiento con prednisona.

El folleto de Tiroiditis para guardar e imprimir (PDF File, 68 KB)

El folleto de Tiroiditis para guardar e imprimir (PDF File, 68 KB)

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What is the thyroid gland?

The thyroid gland located in the neck produces thyroid hormones which help the body use energy, stay warm and keep the brain, heart, muscles, and other organs working normally.

1

Symptoms

What is thyroiditis?
Thyroiditis includes a group of individual disorders that all cause thyroidal inflammation. As a result, there may be many different clinical presentations, from hypothyroidism to an enlarged thyroid (Goiter) to symptoms similar to hyperthyroidism.

2

Causes

What causes thyroiditis?
Thyroiditis results from an attack on the thyroid, causing inflammation and damage to the thyroid cells. Antibodies that attack the thyroid cause most types of thyroiditis. Certain drugs or an infection by a virus or bacteria may also cause Thyroiditis.

3

Diagnosis

What are the clinical symptoms of thyroiditis?
There are no symptoms unique to thyroiditis. If the thyroiditis causes slow and chronic thyroid cell damage and destruction, leading to a fall in thyroid hormone levels in the blood, patients experience the symptoms of hypothyroidism (see Hypothyroidism brochure). If the thyroiditis causes rapid thyroid cell damage and destruction, the thyroid hormone that is stored in the gland leaks out, increasing thyroid hormone levels in the blood. These patients experience the symptoms of thyrotoxicosis, which are similar to hyperthyroidism (see Hyperthyroidism brochure). Pain in the thyroid can be seen in patients with subacute thyroiditis.

What are the types and clinical course of thyroiditis?

Hashimoto’s thyroiditis – Patients usually present with hypothyroidism, which is usually permanent.

Subacute, painless and post-partum thyroiditis – These disorders follow the same general clinical course of thyrotoxicosis followed by hypothyroidism. The thyrotoxic phase usually lasts for 1-3 months and is associated with symptoms including anxiety, insomnia, palpitations (fast heart rate), fatigue, weight loss, and irritability. Thyroidal pain in subacute thyroiditis follows the thyrotoxic phase. The hypothyroid phase typically occurs 1-3 months after the thyrotoxic phase and may last up to 9 –12 months. Typical symptoms include fatigue, weight gain, constipation, dry skin, depression and poor exercise tolerance. Most patients (80-95%) will have return of their thyroid function to normal within 12-18 months of the onset of symptoms.

Drug-induced and radiation thyroiditis – Both thyrotoxicosis and hypothyroidism may be seen. The thyrotoxicosis is usually shortlived. Drug-induced hypothyroidism often resolves with the cessation of the drug, while the hypothyroidism related to radiation thyroiditis is usually permanent.

Acute/Infectious thyroiditis – Symptoms may include thyroidal pain, systemic illness, painless enlargement of the thyroid and hypothyroidism. The symptoms usually resolve once the infection resolves.

4

Treatment

How is thyroiditis treated?
Treatment depends on the type of thyroiditis and the clinical presentation.

Thyrotoxicosis – Beta blockers to decrease palpitations and reduce shakes and tremors may be helpful. Antithyroid medications (see Hyperthyroid brochure) are not used for the thyrotoxic phase of thyroiditis of any kind since the thyroid is not truly overactive.

Hypothyroidism – Treatment is initiated with thyroid hormone replacement for hypothyroidism due to Hashimoto’s thyroiditis (see Thyroid Hormone Therapy brochure). If thyroid hormone therapy is begun in patients with subacute, painless and post-partum thyroiditis, treatment should be continued for approximately 6-12 months and then tapered to see if thyroid hormone is required permanently.

Thyroidal pain – The pain associated with subacute thyroiditis usually can be managed with mild anti-inflammatory medications such as aspirin or ibuprofen. Occasionally, the pain can be severe and require steroid therapy with prednisone.

Thyroiditis FAQ for Saving and Printing (PDF File, 148 KB)

Thyroiditis FAQ for Saving and Printing (PDF File, 92 KB)

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What is the thyroid gland?

The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. The thyroid’s job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormone helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should.

What is thyroiditis?

Thyroiditis is a general term that refers to “inflammation of the thyroid gland”. Thyroiditis includes a group of individual disorders causing thyroidal inflammation but presenting in different ways. For example, Hashimoto’s thyroiditis is the most common cause of hypothyroidism in the United States. Postpartum thyroiditis, which causes temporary thyrotoxicosis (high thyroid hormone levels in the blood) followed by temporary hypothyroidism, is a common cause of thyroid problems after the delivery of a baby. Subacute thyroiditis is the major cause of pain in the thyroid. Thyroiditis can also be seen in patients taking the drugs interferon and amiodarone.

What are the clinical symptoms of thyroiditis?

There are no symptoms unique to thyroiditis. If the thyroiditis causes slow and chronic thyroid cell damage and destruction, leading to a fall in thyroid hormone levels in the blood, patients experience the symptoms of of hypothyroidism (see Hypothyroidism brochure). Typical hypothyroid symptoms include fatigue, weight gain, constipation, dry skin, depression and poor exercise tolerance. This would be the case in patients with Hashimoto’s thyroiditis. If the thyroiditis causes rapid thyroid cell damage and destruction, the thyroid hormone that is stored in the gland leaks out, increasing thyroid hormone levels in the blood. These patients will experience the symptoms of thyrotoxicosis, which are similar to hyperthyroidism (see Hyperthyroidism brochure). These symptoms often include anxiety, insomnia, palpitations (fast heart rate), fatigue, weight loss, and irritability. This is seen in patients with the toxic phase of subacute, painless and post-partum thyroiditis. The symptoms of thyrotoxicosis and hyperthyroidism are both caused by elevated levels of thyroid hormone in the blood, but in thyrotoxicosis, the gland is not truly overactive. In subacute, painless and post-partum thyroiditis, the thyroid gland often becomes depleted of thyroid hormone as the course of inflammation continues leading to a fall in thyroid hormone levels in the blood and symptoms of hypothyroidism. Pain in the thyroid can be seen in patients with subacute thyroiditis

What causes thyroiditis?

Thyroiditis is caused by an attack on the thyroid, causing inflammation and damage to the thyroid cells. Antibodies that attack the thyroid cause most types of thyroiditis. As such, thyroiditis is often an autoimmune disease, like juvenile diabetes and rheumatoid arthritis. No one knows why certain people make thyroid antibodies, although this tends to run in families. Thyroiditis can also be caused by an infection, such as a virus or bacteria, which works in the same way as antibodies to cause inflammation in the gland. Finally, drugs such as interferon and amiodarone, can also damage thyroid cells and cause thyroiditis.

What is the clinical course of thyroiditis?

The course of thyroiditis depends on the type of thyroiditis.

Hashimoto’s thyroiditis –Patients usually present with hypothyroidism, which is usually permanent.

Painless and post-partum thyroiditis – These disorders are similar and follow the same general clinical course of thyrotoxicosis followed by hypothyroidism. The only real difference between them is that post-partum thyroiditis occurs after the delivery of a baby while painless thyroiditis occurs in men and in women not related to a pregnancy. Not all patients demonstrate evidence of going through both phases; approximately 1/3 of patients will manifest both phases, while 1/3 of patients will have only a thyrotoxic or hypothyroid phase. The thyrotoxic phase lasts for 1-3 months and is associated with symptoms including anxiety, insomnia, palpitations (fast heart rate), fatigue, weight loss, and irritability. The hypothyroid phase typically occurs 1-3 months after the thyrotoxic phase and may last up to 9 – 12 months. Typical symptoms include fatigue, weight gain, constipation, dry skin, depression and poor exercise tolerance. Most patients (~80%) will have return of their thyroid function to normal within 12- 18 months after the onset of symptoms.

Subacute thyroiditis – Subacute thyroiditis follows the same clinical course as painless and post-partum thyroiditis, but is often accompanied by thyroidal pain. The thyroidal pain in patients with subacute thyroiditis usually follows the same time-frame of the thyrotoxic phase (1-3 months). However, not all patients with thyroidal pain necessarily have thyrotoxicosis. As noted with painless and post-partum thyroiditis, resolution of all thyroidal abnormalities after 12-18 months is seen in most patients (~95%). Recurrence of subacute thyroiditis is rare.

Drug-induced and radiation thyroiditis – Both thyrotoxicosis and hypothyroidism may be seen in these disorders. The thyrotoxicosis is usually short-lived. Drug-induced hypothyroidism often resolves with the cessation of the drug, while the hypothyroidism related to radiation thyroiditis is usually permanent.

Acute/Infectious thyroiditis – Symptoms may include thyroidal pain, systemic illness, painless enlargement of the thyroid and hypothyroidism. The symptoms usually resolve once the infection resolves.

What are the Types of Thyroiditis?

There are many types of thyroiditis, which are summarized in the table below:

How is thyroiditis treated?

Treatment depends on the type of thyroiditis and the clinical presentation.

• Thyrotoxicosis – Beta blockers to decrease palpitations and reduce shakes and tremors may be helpful. As symptoms improve, the medication is tapered off since the thyrotoxic phase is temporary. Antithyroid medications (see Hyperthyroid brochure) are not used for the thyrotoxic phase of thyroiditis of any kind since the thyroid is not overactive.
• Hypothyroidism – Treatment is initiated with thyroid hormone replacement for hypothyroidism due to Hashimoto’s thyroiditis (see Thyroid Hormone Treatment brochure). In patients who are symptomatic with the hypothyroid phase of subacute, painless and post-partum thyroiditis, thyroid hormone therapy is also indicated. If the hypothyroidism in these latter disorders is mild and the patient has few, if any, symptoms, then no therapy may be necessary. If thyroid hormone therapy is begun in patients with subacute, painless and post-partum thyroiditis, the treatment should be continued for approximately 6-12 months and then tapered to see if it is required permanently.
• Thyroidal pain – The pain associated with subacute thyroiditis usually can be managed with mild anti-inflamatory medications such as aspirin or ibuprofen. Occasionally, the pain can be severe and require steroid therapy with prednisone.

Further Information

Further details on this and other thyroid-related topics are available in the patient information section on the American Thyroid Association^® website at www.thyroid.org.

Thyroiditis Brochure for Saving and Printing (PDF File, 453 KB)

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