Autoimmune Thyroiditis - How to Diagnose and How Long to Treat

Majority of patients in the age group of 12 to 25elevated FT3 & FT4 associated with
years attending the out patient clinic of thedecreased TSH confirming that they were in the
Department of Endocrine Surgery, Governmenttoxic phase of thyroiditis.Hence, those patients
General Hospital,Chennai ( a tertiary care Hospitalwere treated with beta blocker propranolol.
in South India) are suffering from Thyroiditis. MostAntiThyroglobulin antibody titre was used to
of these patients seek medical aid when theydifferentiate Toxic phase of thyroiditis from
develop a diffuse goiter. Some of them presentedGraves' disease. Toxic phase of thyroiditis is due
with palpitation and tremors without thyromegalyto increased liberation of stored hormone in to
but the majority of patients presented withthe system, due to follicular damage and not due
diffuse goiter in Hypothyroid state.to increased production of thyroid
Investigations done to confirm the diagnosis: (1)hormone.Patients in toxic phase of thyroiditis
FT3,FT4,TSH (2)Thyroid antibodies:developed severe hypothyroidism when treated
Antimicrosomal antibody (TPO) and Antiwith antithyroid drug carbimazole for a few
thyroglobulin antibody(ATG) and (3) Fine Needleweeks.
Aspiration CytologyFNAC is a very useful investigation to confirm
Thyroiditis is confirmed by positive AntimicrosomalThyroiditis. Cytology revealed Lymphocytic
Antibody titre (AMA). All Thyroiditis patients withinfiltration in all patients with thyroidtis.
diffuse goitre had elevated serum TSH withAMA(TPO) titre became negative in most of our
decreased FT3 & FT4 confirmingpatients over a period of 12 to 18 months. Hence
Hypothyroid status.Hence,they were all treatedthe treatment was given for the same period.
with thryoxine 50 to 100mcg OD. Patients whoNegative AMA(TPO) titre is an indication to
presented with palpitation and tremors hadwithdraw the medical treatment.