Akut ve Subakut Tiroiditler
Özet
Tiroiditler, tiroid bezinde inflamasyon ve folikül hasarı ile seyreden, başlangıç hızına ve ağrı durumuna göre sınıflandırılan heterojen bir hastalık grubudur. Akut (süpüratif) tiroidit, kapsüler yapı ve iyi kanlanma nedeniyle nadir görülen, genellikle gram (+) bakterilerin yol açtığı, belirgin ağrı, yüksek ateş ve abse formasyonu ile karakterize bakteriyel bir enfeksiyondur. Subakut tiroiditler arasında yer alan de Quervain (granülomatöz) tiroiditi, genellikle viral enfeksiyonları takiben oluşan, HLA-B35 ilişkili ve şiddetli boyun ağrısıyla belirginleşen geçici bir destrüksiyon tablosudur. Bu hastalık; sırasıyla hipertiroidik, ötiroidik, hipotiroidik ve iyileşme evrelerinden oluşan klasik bir trifazik seyir izler. Sessiz (ağrısız) tiroidit ve postpartum tiroidit ise otoimmün etiyolojiye sahip, ağrısız guatr ve benzer trifazik hormon dalgalanmalarıyla seyreden Hashimoto varyantlarıdır. Son olarak amiodaron kullanımı, içermiş olduğu yüksek iyot yükü ve doğrudan foliküler toksisite nedeniyle iyoda bağlı tirotoksikoza (Tip 1) veya yıkıcı destrüktif tiroidite (Tip 2) yol açarak tiroid fonksiyonlarını bozabilir. Akut ve subakut tiroiditlerin tedavisinde semptomların kontrolü, antiinflamatuvar ilaçlar, kortikosteroidler ve beta-blokerler ile sağlanırken, kalıcı hipotiroidi gelişen vakalarda levotiroksin desteği gerekir.
Thyroiditis represents a heterogeneous group of disorders characterized by thyroid gland inflammation and follicular cell injury, classified based on the onset of symptoms and the presence of pain. Acute (suppurative) thyroiditis is a rare bacterial infection usually caused by gram-positive pathogens, presenting with severe pain, high fever, and abscess formation despite the gland's inherent resistance to infections. Among subacute forms, de Quervain (granulomatous) thyroiditis is a transient destructive condition associated with HLA-B35 that typically follows viral upper respiratory tract infections and manifests with exquisite neck pain. It characteristically follows a triphasic clinical course: a hyperthyroid phase, a transient euthyroid interval, a hypothyroid phase, and ultimate resolution. Silent (painless) thyroiditis and postpartum thyroiditis are considered autoimmune variants of Hashimoto's thyroiditis, presenting with painless goiter and similar triphasic hormonal fluctuations without local tenderness. Additionally, amiodarone therapy can induce thyroid dysfunction through high iodine content and direct cytotoxicity, leading to either iodine-induced thyrotoxicosis (Type 1) or destructive thyroiditis (Type 2). Management focuses on symptom control using non-steroidal anti-inflammatory drugs, corticosteroids, and beta-blockers, while levothyroxine substitution is indicated for patients who develop permanent hypothyroidism.
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