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Thyroiditis is a group of inflammatory thyroid disorders. Patients with chronic lymphocytic thyroiditis (also referred to as Hashimoto's thyroiditis) present with hypothyroidism, goiter, or both. Measurement of serum thyroid autoantibodies and thyroglobulin confirms the diagnosis. Subacute granulomatous thyroiditis (sometimes referred to as cle Quervain's disease) is a self-limited but painful disorder of the thyroid. Physical examination, elevated erythrocyte sedimentation rate, elevated thyroglobulin level and depressed radioactive iodine uptake (RAIU) confirm the diagnosis. Subacute lymphocytic thyroiditis (silent thyroiditis) is considered autoimmune in origin and commonly occurs in the postpartum period. Symptoms of hyperthyroidism and depressed RAW predominate. Acute (suppurative) thyroiditis is a rare, infectious thyroid disorder caused by bacteria and other microbes. The rare, invasive fibrous thyroiditis (Riedel's thyroiditis) presents with a slowly enlarging anterior neck mass that is sometimes confused with a malignancy. (Am Fam Physician 2000;61:1047-52,1054.)
Thyroiditis refers to a group of inflammatory diseases affecting the thyroid gland (Table 1). With the help of historical information, a physical examination and diagnostic tests, physicians can classify the type of thyroiditis and initiate appropriate treatment.
Chronic Lymphocytic Thyroiditis
Chronic lymphocytic thyroiditis (Hashimoto's thyroiditis) is the most common inflammatory condition of the thyroid gland and the most common cause of goiter in the United States.1,2 It is an autoimmune condition characterized by high titers of circulating antibodies to thyroid peroxidase and thyroglobulin.3
EPIDEMIOLOGY
Chronic lymphocytic thyroiditis is the most common cause of hypothyroidism in the United States, and euthyroid persons with Hashimoto's disease develop hypothyroidism at a rate of approximately 5 percent per year.4 Up to 95 percent of cases of chronic lymphocytic thyroiditis occur in women, usually between 30 and 50 years of age.5 Chronic lymphocytic thyroiditis is also the most common cause of sporadic goiter in children.5,6 The incidence of Hashimoto's disease has risen exponentially over the past 50 years, and this increase may be related to an increased iodine content in the North American diet.6
A genetic predisposition to thyroid autoimmunity exists; it is inherited as a dominant trait.7 Hashimoto's disease has been linked to other autoimmune diseases, including systemic lupus erythematosus, rheumatoid arthritis, pernicious anemia, diabetes mellitus and Sj6grer's syndrome.5 A rare but serious complication of chronic autoimmune thyroiditis is thyroid lymphoma.7 These lymphomas, generally the B-cell, non-Hodgkin's type, tend to...