History
Acute thyroiditis
A history of acute illness, including fever, chills, neck pain, sore throat, hoarseness, and dysphagia, is common.
Neck pain is frequently unilateral and radiates to the mandible, ears, or occiput. Neck flexion reduces the severity of the pain. The pain worsens with neck hyperextension.
Subacute thyroiditis
Neck tenderness and swelling may occur.
Occasionally, the initial symptoms are those of hyperthyroidism.
Systemic symptoms such as weakness, fatigue, malaise, and fever are usually low grade.
Chronic autoimmune thyroiditis
Chronic autoimmune thyroiditis is observed in the following 3 patterns:
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Goiter that is usually diffuse and nontender: Systemic illness is not evident. The thyroid gland is frequently 2-3 times its normal size and may be larger. The patient, parent, or physician may discover the goiter.
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Symptoms of hypothyroidism: In children, this frequently includes poor growth or short stature. Adolescent girls may have primary or secondary amenorrhea. Boys may have delayed puberty. Because the disease develops slowly, the patient or parent may not notice other signs of hypothyroidism, including constipation, lethargy, and cold intolerance. The child with diabetes may have decreasing insulin requirement.
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Symptoms of hyperthyroidism: These may include poor attention span, hyperactivity, restlessness, heat intolerance, or loose stools.
Asymptomatic thyroiditis
Asymptomatic thyroiditis with or without thyroid function abnormalities may also be discovered upon routine screening of children at high risk; these include children with Down syndrome or Turner syndrome and children with other autoimmune endocrine disorders (eg, type 1 diabetes, Addison disease, vitiligo).
Celiac disease
The prevalence of celiac disease is increased in those with autoimmune thyroid disease and comorbidities such as type 1 diabetes and Down syndrome. [18]
Physical
Acute thyroiditis
The patient may have a fever of 38-40°C.
Acute illness may be evident.
Neck tenderness is present, and the swollen thyroid gland is tender. The swelling and tenderness may be unilateral. Erythemas develop over the gland, and regional lymphadenopathy may develop as the disease progresses. Abscess formation may occur.
Subacute thyroiditis
The patient may have signs of systemic illness, such as low-grade fever and weakness.
Signs of hyperthyroidism, including increased pulse rate, widened pulse pressure, fidgeting, tremor, nervousness, tongue fasciculations, brisk reflexes (possibly with clonus), weight loss, and warm, moist skin, may be present.
The thyroid gland may be enlarged and tender, with tenderness exacerbated by neck extension.
Chronic autoimmune thyroiditis
Initially, an enlarged, lumpy, bumpy, and nontender thyroid is often present. The gland may not be enlarged, particularly in children who have profound hypothyroidism. Signs of hypothyroidism include slow growth rate; weight gain; slow pulse; cold, dry skin; coarse hair and facial features; edema; and delayed relaxation of the deep tendon reflexes.
Signs of hyperthyroidism are occasionally present early in the disease.
Causes
Acute suppurative thyroiditis is more common in poorer geographic areas where antibiotic use is less prevalent. It usually occurs in children with embryologic abnormalities such as a persistent thyroglossal duct or brachial cleft cysts.
Chronic autoimmune thyroiditis is more common in developed countries with increased iodine intake.
Children with Down syndrome or Turner syndrome and those who have type 1 diabetes or another autoimmune endocrine disease are at particular risk of chronic thyroiditis.
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Three multinuclear, giant cell granulomas observed in a fine-needle aspiration biopsy of the thyroid; from a patient with thyrotoxicosis from lymphocytic or subacute granulomatous thyroiditis.
