Sweeney Lori B, Stewart Christopher, Gaitonde David Y
Virginia Commonwealth University Health System, Richmond, VA, USA.
Bayne-Jones Army Community Hospital, Fort Polk, LA, USA.
Am Fam Physician. 2014 Sep 15;90(6):389-96.
Thyroiditis is a general term that encompasses several clinical disorders characterized by inflammation of the thyroid gland. The most common is Hashimoto thyroiditis; patients typically present with a nontender goiter, hypothyroidism, and an elevated thyroid peroxidase antibody level. Treatment with levothyroxine ameliorates the hypothyroidism and may reduce goiter size. Postpartum thyroiditis is transient or persistent thyroid dysfunction that occurs within one year of childbirth, miscarriage, or medical abortion. Release of preformed thyroid hormone into the bloodstream may result in hyperthyroidism. This may be followed by transient or permanent hypothyroidism as a result of depletion of thyroid hormone stores and destruction of thyroid hormone-producing cells. Patients should be monitored for changes in thyroid function. Beta blockers can treat symptoms in the initial hyperthyroid phase; in the subsequent hypothyroid phase, levothyroxine should be considered in women with a serum thyroid-stimulating hormone level greater than 10 mIU per L, or in women with a thyroid-stimulating hormone level of 4 to 10 mIU per L who are symptomatic or desire fertility. Subacute thyroiditis is a transient thyrotoxic state characterized by anterior neck pain, suppressed thyroid-stimulating hormone, and low radioactive iodine uptake on thyroid scanning. Many cases of subacute thyroiditis follow an upper respiratory viral illness, which is thought to trigger an inflammatory destruction of thyroid follicles. In most cases, the thyroid gland spontaneously resumes normal thyroid hormone production after several months. Treatment with high-dose acetylsalicylic acid or nonsteroidal anti-inflammatory drugs is directed toward relief of thyroid pain.
甲状腺炎是一个通用术语，涵盖了几种以甲状腺炎症为特征的临床病症。最常见的是桥本甲状腺炎；患者通常表现为无痛性甲状腺肿、甲状腺功能减退以及甲状腺过氧化物酶抗体水平升高。左甲状腺素治疗可改善甲状腺功能减退，并可能缩小甲状腺肿的大小。产后甲状腺炎是在分娩、流产或药物流产后一年内发生的短暂性或持续性甲状腺功能障碍。预先形成的甲状腺激素释放到血液中可能导致甲状腺功能亢进。随后可能会因甲状腺激素储备耗竭和甲状腺激素产生细胞破坏而出现短暂性或永久性甲状腺功能减退。应对患者的甲状腺功能变化进行监测。β受体阻滞剂可治疗初始甲状腺功能亢进阶段的症状；在随后的甲状腺功能减退阶段，对于血清促甲状腺激素水平大于每升1０ｍＩＵ的女性，或血清促甲状腺激素水平为每升4至1０ｍＩＵ且有症状或渴望生育的女性，应考虑使用左甲状腺素。亚急性甲状腺炎是一种短暂性甲状腺毒症状态，其特征为颈部前方疼痛、促甲状腺激素受抑制以及甲状腺扫描时放射性碘摄取降低。许多亚急性甲状腺炎病例在发生上呼吸道病毒性疾病后出现，据认为这会引发甲状腺滤泡的炎性破坏。在大多数情况下，甲状腺在数月后会自发恢复正常的甲状腺激素分泌。大剂量乙酰水杨酸或非甾体类抗炎药治疗旨在缓解甲状腺疼痛。
