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Avoid radioisotope scanning if possible.
Keep TSH maximally suppressed.
If using RAIU scan, discard breast milk for 2 days because RAI is secreted in breast milk.
PROGNOSIS
- Hashimoto disease: persistent goiter; eventual thyroid failure
- Subacute granulomatous thyroiditis: 5 " 15% hypothyroid beyond a year: Some with eventual return to normal; remission may be slower in the elderly; recurrence rate: 1 " 4% after a year
- Painless (silent) thyroiditis: 10 " 20% hypothyroid beyond a year; recurrence rate 5 " 10% (much higher in Japan)
- Postpartum thyroiditis: 15 " 50% hypothyroid beyond a year; women may be euthyroid/continue to be hypothyroid at the end of 1st postpartum year. 70% recurrence rate in subsequent pregnancies; substantial risk exists for later development of hypothyroidism/goiter.
REFERENCES
11 Samuels MH. Subacute, silent, and postpartum thyroiditis. Med Clin North Am. 2012;96(2):223 " 233.22 Li Y, Nishihara E, Kakudo K. Hashimoto 's thyroiditis: old concepts and new insights. Curr Opin Rheumatol. 2011;23(1):102 " 107.33 De Groot L, Abalovich M, Alexander EK, et al. Management of thyroid dysfunction during pregnancy and postpartum: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2012;97(8):2543 " 2565. doi:10.1210/jc.2011-280344 Hennessey JV. Clinical review: Riedel 's thyroiditis: a clinical review. J Clin Endocrinol Metab. 2011;96(10):3031 " 3041.55 Reid SM, Middleton P, Cossich MC, et al. Interventions for clinical and subclinical hypothyroidism in pregnancy. Cochrane Database Syst Rev. 2010;(7):CD007752.
ADDITIONAL READING
Duntas LH. Selenium and the thyroid: a close-knit connection. J Clin Endocrinol Metab. 2010;95(12):5180 " 5188.
SEE ALSO
Hyperthyroidism; Hypothyroidism, Adult
CODES
ICD10
- E06.9 Thyroiditis, unspecified
- E06.1 Subacute thyroiditis
- E06.0 Acute thyroiditis
- E06.4 Drug-induced thyroiditis
- E06.3 Autoimmune thyroiditis
- E06.5 Other chronic thyroiditis
- E06.2 Chronic thyroiditis with transient thyrotoxicosis
ICD9
- 245.9 Thyroiditis, unspecified
- 245.1 Subacute thyroiditis
- 245.0 Acute thyroiditis
- 245.4 Iatrogenic thyroiditis
- 245.2 Chronic lymphocytic thyroiditis
- 245.8 Other and unspecified chronic thyroiditis
- 245.3 Chronic fibrous thyroiditis
SNOMED
- 82119001 Thyroiditis (disorder)
- 428041004 Subacute granulomatous thyroiditis
- 190293001 Acute thyroiditis
- 61556008 Iatrogenic thyroiditis (disorder)
- 3511005 Infectious thyroiditis
- 84362007 Fibrous autoimmune thyroiditis
- 21983002 Hashimoto thyroiditis (disorder)
CLINICAL PEARLS
- TSH elevation above the normal range indicates a hypothyroid state; suppressed TSH indicates hyperthyroid state. Follow up with free T3/T4 determination.
- Follow patients on thyroid replacement with periodic TSH level.