Subacute Thyroiditis and Chronic Lymphocytic Thyroiditis January 8, 1996

Subacute Thyroiditis and Chronic Lymphocytic Thyroiditis January 8, 1996

Both conditions are autoimmune disorders. The former often develops following an upper respiratory tract infection, accompanied by pharyngeal swelling and pain, as well as thyroid enlargement and tenderness; the latter usually progresses insidiously, with thyroid enlargement being the most common manifestation. Hence, the former is termed subacute, while the latter is called chronic. A shared characteristic of both is: ① positive thyroglobulin antibodies; ② elevated serum protein-bound iodine with decreased thyroid iodine uptake; ③ abnormal plasma protein ratios and increased gamma globulins; ④ accelerated erythrocyte sedimentation rate; ⑤ fluctuating T3 and T4 levels depending on disease progression. Both conditions follow a chronic course, during which hyperthyroidism and hypothyroidism may alternate. In my experience, hyperthyroidism tends to occur more frequently during infections, whereas hypothyroidism is more common when there is no infection. Patients with subacute thyroiditis often exhibit hyperthyroidism, while those with chronic lymphocytic thyroiditis tend to have hypothyroidism; the latter is also known as Hashimoto's disease, discovered by Japanese physician Dr. Hakaru Hashimoto in 1956. Western medical treatment primarily involves adrenal corticosteroids, with levothyroxine tablets (10 mg) prescribed for hypothyroidism, taken orally 1–3 times daily. Some argue that only early-stage Hashimoto's disease warrants steroid therapy (adrenal cortex hormones), but this view is incorrect. Approximately 50% of advanced Hashimoto's cases present with hypothyroidism, whose symptoms can generally be categorized into five types: ① fatigue, aversion to cold, drowsiness, bradycardia, hair loss, and myxedema; ② abdominal distension and poor appetite, reduced intestinal peristalsis, and constipation, with occasional cases of paralytic ileus; ③ waxy yellow skin, lack of luster, dryness, and scaling, non-pitting edema, enlarged tongue with unclear articulation, narrowed palpebral fissures, and thickened lips and wings; ④ slowed reactions, diminished comprehension, and impaired vision, hearing, touch, and smell, with some patients experiencing hallucinations, dementia, psychiatric disorders, or abnormal EEG readings; ⑤ moderate anemia and muffled heart sounds, with prolonged PR interval and widened QRS complex on ECG.