Thyroiditis: Symptoms to sequelae - An Indian experience

Introduction: Thyroiditis presents with symptoms varying from thyrotoxicosis to hypothyroidism. In fairly a large number of patients the symptoms are very subtle and hence clinical diagnosis is difficult to make without laboratory assistance. In view of this we undertook a study to assess the patterns of clinical presentation and the behavioral pattern of patients with thyroiditis. Materials and Methods: Totally 43 patients were included in the study with clinical suspicion of thyroiditis. 31 patients presented with symptoms of thyrotoxicosis while 6 patients presented with hypothyroid symptoms. Six patients presented with history of acute upper respiratory tract infection with tender thyromegaly and euthyroid status. These patients were subjected to thyroid scan (43 patients), sonography (6 patients), thyroid antibody levels estimation (43 patients), FNAC evaluation (3 patients) and T3, T4, TSH estimation (43 patients). The patients were followed up for a period of 6 months to 2 years. Clinical evaluation and T3, T4 and TSH evaluation was performed. Result: 19 of the 31 patients (61.29%) who presented with thyrotoxicosis progressed to hypothyroid state both clinically and biochemically. 11 of the 31 patients (35.48%) reverted to euthyroid status. One patient continued to maintain thyrotoxic state at the end of 2 years and was treated with antithyroid measures. In the hypothyroid group of six patients, four patients continued to maintain hypothyroid state while two patients reverted to euthyroid status during follow up. In the euthyroid group of six patients four patients developed hypothyroid status and the other two patients remained euthyroid. The 99m- Tco4 scan demonstrated poor and patchy uptake in all the patients. Conclusion: Our study demonstrated that majority of the patients (72.09%) of thyroiditis present with thyrotoxic symptoms. The sequelae of hypothyroidism was seen in 61.29% of patients in this group. We observed an interesting finding of patients reverting to euthyroid status in two of the six of those who clinically presented with hypothyroidism