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