The Basis of Thyroiditis Symptoms
The most practical treatise on thyroiditis symptoms for patients is one which compares the symptoms on the basis of the different types of the disease. First of all though, thyroiditis is inflammation of the thyroid gland. The speed of onset, severity, course and cause of inflammation of the gland are factors that denote its type. The gland’s location, the degree of inflammation and the effect(s) that the disease has on the function of the gland are factors that determine its symptoms. Importantly, the phase of some types determines the effect on thyroid function. Depending on the disease type, symptoms might be those of hypothyroidism or hyperthyroidism which might change or alternate over time.
Types of Thyroiditis
Based on the degree, cause and course of the inflammation there are basically five main types of thyroiditis. They are:
- Acute (infectious) thyroiditis
- Chronic autoimmune thyroiditis (Hashimoto’s thyroiditis)
- Subacute thyroiditis
- Postpartum thyroiditis
- Silent thyroiditis
There are some other less common presumed autoimmune types as well as forms caused by certain drugs. Radiation is another cause.
Hypothyroidism is an underactive thyroid gland which does not produce sufficient amounts of the hormones that regulate the body’s metabolism. Consequently it leads to a decrease in the body’s rate of metabolism.
Common underactive thyroid symptoms are the following:
- Fatigue and fatigability
- Feeling cold or difficulty tolerating cold temperatures
- Excessive hair loss
- Dry skin
- Facial puffiness
- Brittle nails
- Muscle aches
- Heavy or irregular menstrual periods
Hyperthyroidism is a condition in which the thyroid gland is overactive in its production of hormones. As a result, the body’s rate of metabolism is increased. Common overactive thyroid symptoms and signs are the following:
- Rapid heart rate
- Nervousness and irritability
- Increased sweating
- Increased skin warmth
- Increased appetite
- Weight loss
- Change in bowel movements (usually an increase in the frequency)
- Heat intolerance
- Difficulty sleeping
Thyroiditis Symptoms Based on Disease Type and Phase
There are a number of possible thyroiditis symptoms. They vary based on the type of disease and the stage of the disease on a timescale in relationship to its onset. Those symptoms are the following:
- Anterior neck pain (an the area where the thyroid is located)
- Dysphagia (difficulty swallowing)
- Dysphonia (difficulty speaking)
Acute (Infectious) Thyroiditis
Acute thyroiditis is a form of the disease that develops suddenly and is associated with considerable inflammation. For that reason it can cause pain in the lower front area of the neck where the thyroid gland is located. The source of the infection is usually bacterial but other pathogens can also cause it. Because of the acute infection it can cause chills and fever. The course of the disease is usually short-lived, usually due to effective treatment to cure it. Therefore it does not usually cause any symptoms related to an effect on the function of the gland. Because of the rich blood supply of the thyroid, it is not easily infected. Therefore, this form is not that common.
This form also bears the name chronic autoimmune thyroiditis. The inflammation develops gradually and to a lesser degree, in contrast to that of the acute and subacute forms of the disease. The cause of the inflammation is the immune system’s production of antibodies against tissue of the thyroid gland. A goiter is usually the earliest sign of the disease. It might cause some difficulty swallowing, breathing or speaking due to local pressure on nearby structures, depending on the size of the gland. Pain in the front lower part of the neck might be an attribute but to a much lesser degree than the pain which is a symptom of acute or subacute disease.
The main symptoms associated with the disease are those related to the effect that the disease has on the function of the thyroid gland. Overactive thyroid symptoms are rarely ever experienced with this form of the disease because the gland almost never produces too much hormone. A fairly small number of the cases have underactive thyroid symptoms at the time of the diagnosis because of deficient hormone production by the gland at that time. More commonly though the hormone production wanes years later after parts of the gland undergo destruction. Thus, underactive thyroid symptoms don’t appear until that time. Treatment with thyroid hormone eliminates and prevents those symptoms.
Subacute thyroiditis is a transient state of inflammation of the thyroid gland. It oftentimes occurs within 30 days of an upper respiratory tract infection. Hence, a viral infection is the presumed trigger. The cardinal symptom is pain in the anterior neck.
Because of the inflammation the thyroid gland releases hormone into the bloodstream. This causes a transient increase in the blood concentration of thyroid hormones. The result is short-term overactive thyroid symptoms and signs. This phase of the disease typically last for 4 to 8 weeks. After the inflammation subsides, transient hypothyroidism might develop with underactive thyroid symptoms and signs.
The disease is usually self-limited (runs a limited course) with hormone production returning to normal after several months. Researchers have observed though that the hypothyroid phase can be permanent in up to 15% of patients. They have also reported cases of it developing more than one year following the onset of the disease. It is rare but not impossible for patients to experience recurrent bouts of subacute thyroiditis.
Postpartum thyroiditis is dysfunction of the thyroid gland which occurs following childbirth. The triggering event can be a normal delivery, a miscarriage, or an abortion, usually within one year prior to its onset.
It is similar to Hashimoto’s disease in that it is associated with the immune system’s production of antibodies against cells and tissues of the thyroid gland. In that sense, it appears to be the unmasking of an autoimmune disease. Transient overactive thyroid symptoms tend to be present early on as the inflamed gland releases hormones into the bloodstream. The symptoms might overlap those of Graves’ disease, but are usually milder. A major point of distinction though is the absence of exophthalmos seen with Graves’ disease.
Hypothyroidism with underactive thyroid symptoms might ensue due to damage to portions of the gland. This hypothyroid phase usually begins within four to eight months of the triggering event. It typically lasts for four to six months, but can be permanent in up to 25% of women. Lifelong treatment with thyroid hormone rids and prevents the underactive thyroid symptoms.
Silent thyroiditis is similar to postpartum thyroiditis in that it appears to be of autoimmune origin and can have a hypothyroid or hyperthyroid phase. It differs though in that its onset is unrelated to childbirth. Its clinical presentation can be any of the following:
- Hyperthyroidism alone with overactive thyroid symptoms
- Hyperthyroidism followed by hypothyroidism with overactive thyroid symptoms followed by underactive thyroid symptoms
- Hypothyroidism alone with underactive thyroid symptoms
It is less likely than the postpartum disease to result in permanent hypothyroidism.