What are silent thyroiditis, pregnancy thyroiditis, subacute thyroiditis? How should the treatment be followed? What are the differences?

When thyroiditis is mentioned, thyroid gland inflammations come to mind, which are very diverse. Very few of them develop inflammation due to microbes and these are called acute thyroiditis. We will not talk about these thyroiditis in this article. Our main focus will be on subacute thyroiditis, silent thyroiditis, and germ-free inflammatory thyroiditis that develop during and after pregnancy. How they develop, why they develop, how they should be treated, how much they should be followed up, and what kind of approach they should be used for differential diagnosis have always been among the biggest problems of us as physicians. Therefore, patients were often misdiagnosed and received wrong follow-up and treatment. Most of them were permanently hypothyroid or thought to have Graves’ disease and were exposed to very aggressive thyroid treatments and eventually became drug prisoners for life. However, all of these diseases are mostly temporary. Yes, you heard it wrong …. Almost all of these diseases are temporary. We can totally get over it. There is never a permanent state of toxic or lazy goiter. Everything will pass in six months at the latest. However, if the correct diagnosis is made and treated, this is the case, unfortunately….
It means that it is very important to define the disease in the first place. In fact, all three diseases are very similar. They are immune-based. In subacute thyroiditis, it is highly likely that we have had a previous viral infection. It starts with severe tenderness and pain in the region of our thyroid gland in our anterior neck region. The shivering makes the fever lightly. It progresses with sedimentation and high CRP. Thyroid autoantibodies are negative. The first month is the toxic thyroiditis phase, which we call thyrotoxicosis, then it shifts slightly to the hypothyroid and/or euthyroid phase… And sedimentation crp returns to normal. In this period, physicians only use nonsteroidal anti-inflammatory agents as treatment, and steroids if it is too difficult… They never give thyroid hormones or antithyroid drugs!!!!! These can be very damaging to the thyroid gland because… Beta-blockers are helpful in regulating the palpitations and peripheral effects in these patients…..
Silent thyroiditis is different again. Autoantibodies can also be negative or positive. It is usually positive. It takes longer. It takes 1-6 months. Sometimes the need for very low L-thyroxine in the hypo phase may be for a few months, but usually not … Steroids are usually not required in this patient group. Thyroid scintigraphy is well-suited for diagnosing thyrotoxicosis, that is, in the toxic phase… Doppler USG also helps. However, seeing that the uptakes of the gland are reduced makes a definitive diagnosis. The thyrotoxic phase usually does not last longer than one to two months. And the antithyroid agent is never used, this can cause permanent thyroid damage. Iodine must be cut off. Non-iodized salt is recommended.
Thyroid function tests are followed every 2-4 weeks.
Gestational thyroiditis is the form of silent thyroiditis that is usually seen in the third-fourth month after. Its development is the same and it is reversible. As long as the correct diagnosis is made.
However, iodine is not stopped during lactation, that is, breastfeeding, because iodine is very important for the baby’s secha development and thyroid gland, and the mother’s need for iodine has increased a lot. (about two and a half times) therefore we do not give iodine-free diet. Only follow-up, nonsteroidal anti-inflammatories, beta-blockers can be given if necessary.
THE ROLE OF VITAMINS
As in every immune event, vitamin deficiencies are thought to have a triggering role in such events. It has been observed that selenium and zinc supplementation, coenzyme Q 10 and vitamin c supplementation accelerate the treatment process in silent thyroiditis. If there is a vitamin D deficiency, it should be corrected. Likewise, b12 folate deficiency should be corrected.
There is definitely a familial predisposition in silent thyroiditis.
True nodules may develop in the coming years in the heterogeneous field floor that occurs in the USG. For this reason, these patients should undergo USG control every two to three years after surviving the disease.