Deferred Lymphocytic Thyroiditis

A deferred lymphocytic thyroiditis is a self-limiting, subacute disorder that usually occurs in women in the postpartum period. First, there are signs of hyperthyroidism, then hypothyroidism, and finally a return to normal thyroid function takes place. Treatment during the hyperthyroid phase occurs with beta-blockers. If hypothyroidism is not regressing, a lifelong therapy with thyroxine is necessary.

A deferred lymphocytic thyroiditis is a self-limiting, subacute disorder that usually occurs in women in the postpartum period. First, there are signs of hyperthyroidism, then hypothyroidism, and finally a return to normal thyroid function takes place. Treatment during the hyperthyroid phase occurs with beta-blockers. If hypothyroidism is not regressing, a lifelong therapy with thyroxine is necessary.

(See illustration of the thyroid function.) A deferred lymphocytic thyroiditis is a self-limiting, subacute disorder that usually occurs in women in the postpartum period. First, there are signs of hyperthyroidism, then hypothyroidism, and finally a return to normal thyroid function takes place. Treatment during the hyperthyroid phase occurs with beta-blockers. If hypothyroidism is not regressing, a lifelong therapy with thyroxine is necessary. The term latent refers to the absence of pain in the thyroid and stands in contrast to subacute thyroiditis, which is associated usually with a painful thyroid. The latent lymphocytic thyroiditis causes most cases of postpartum thyroid disorders. It occurs approximately 5-10% of women after childbirth. A thyroid biopsy shows lymphocytic infiltration as in Hashimoto’s thyroiditis, but there are no lymphocytic follicles or scarring. Autoantibodies to thyroid peroxidase, and less frequently against thyroglobulin are almost always positive during pregnancy and the postpartum period in these patients. So this disorder appears to be a variant of Hashimoto’s thyroiditis. Symptoms and signs The disease begins within the first 12-16 weeks of the postpartum period. A latent lymphocytic thyroiditis is characterized by a painless thyroid enlargement with a hyperthyroid phase of several weeks, which is often followed by a transient phase of hypothyroidism because the hormone memory are then emptied, but generally finds a return to normal thyroid function instead (as in the painful subacute thyroiditis). The hyperthyroid phase is self-limiting and can be very short and easy to overlook. Many women with this disorder are not discovered until they show signs of hypothyroidism, which can be rarely permanent. Diagnosis Clinical evaluation determining the values ??of serum thyroxine (T4), triiodothyronine (T3) and thyroid-stimulating hormone (TSH) Deferred lymphocytic thyroiditis often remains undetected. The diagnosis is charged on the basis of clinical findings, typically when hypothyroidism occurred. Changes in the eyes and a pretibial myxedema missing. Depending on the phase of the disease vary the results of thyroid function tests. Initially, the serum levels are elevated for T4 and T3 and TSH is suppressed. During the hypothyroid phase is reversed. The white blood cell count and erythrocyte sedimentation rate are normal. A fine needle biopsy confirms the diagnosis, but is unnecessary. Tips and risks they examine asymptomatic pregnant women on silent lymphocytic thyroiditis, when they had this in previous pregnancies. Therapy usually a beta blocker Sometimes substitution of thyroid hormones. Since the latent lymphocytic thyroiditis lasts only a few months, the treatment is conservative. Normally, it requires only a beta receptor blockade (z. B. with propranolol) during the hyperthyroid phase. Antithyroid drugs, surgery or radioiodine therapy are contraindicated. During the hypothyroid phase substitution with thyroid hormones may be necessary. For most patients, the thyroid function returned to normal, but some hypothyroid stay. Therefore, thyroid function after 9-12 months Thyroxintherapie to be checked again. The substitution is interrupted for 5 weeks and TSH is determined. In subsequent pregnancies, it usually comes to the recurrence of the disorder. Conclusion This disorder affects mostly women in the postpartum period. Most patients go through a temporary hyperthyroid phase followed by a longer hypothyroid phase; almost all recover spontaneously. The disease is often undiagnosed. A beta blocker is often needed during the hyperthyroid phase, and a thyroid hormone replacement usually during the hypothyroid phase.

Health Life Media Team

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