Diagnosis and Treatment of Thyroiditis with Special Reference to the Use of Cortisone and Acth

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THE 2 commonest types of thyroiditis are (1) subacute or giant cell thyroiditis and (2) struma lymphomatosa or Hashimoto’s disease. Variants of the latter type of thyroiditis are common, but in the absence of the characteristic oxyphilia of the cells we classify them as lymphoid thyroiditis, not as true struma lymphomatosa.

Clinical Features of Subacute Thyroiditis

Subacute thyroiditis may manifest itself in a number of different ways. In its most fulminating form, the onset is quite sudden and is associated with severe pain in the thyroid, a high temperature and a marked systemic reaction. Frequently the patients are prostrated by their illness and narcotics may be required to control the pain. More often the disease is milder, is associated with a low-grade temperature and pain in the region of the thyroid which radiates up to the ears and may be interpreted by the patient as a sore throat.

In the chronic form of the disease, there may be little or no pain and tenderness, but the hard enlargement of the thyroid causes an unpleasant sensation of pressure or choking and the hardness of the gland may simulate adenoma or carcinoma of the thyroid.

Subacute thyroiditis usually involves both lobes of the thyroid but may originate on one side and slowly cross the isthmus and involve the other at a later date. The symmetrical involvement of the entire lobe characterizes the process even when only 1 lobe is involved and differentiates it from adenoma and carcinoma which usually are localized to. . .



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