[Thyroiditis: What's new in 2019?]
Fiche publication
Date publication
février 2020
Journal
La Revue de medecine interne
Auteurs
Membres identifiés du Cancéropôle Est :
Pr PETIT Jean-Michel, Pr VERGES Bruno
Tous les auteurs :
Rouland A, Buffier P, Petit JM, Vergès B, Bouillet B
Lien Pubmed
Résumé
Thyroiditis is a frequent and mostly benign disease that can sometimes disrupt the thyroid balance. Their diagnosis, as well as their aetiology, is a necessary step in the management of the patients. Painful thyroiditis includes acute thyroiditis of infectious origin and subacute thyroiditis. The first one can be treated by antibiotics or antifungals depending on the germ found. The second one will be treated with non-steroidal anti-inflammatory drugs or corticosteroids. In cases of Hashimoto's thyroiditis with overt hypothyroidism, replacement therapy with L-thyroxine will be adapted to the TSH level. As amiodarone treatment provides dysthyroidism, the thyroid status should be monitored regularly. Hypothyroidism will be treated using thyroid replacement therapy. Hyperthyroidism imposes a stop of amiodarone when it is possible. Treatment with synthetic antithyroid drugs (propyl-thio-uracil) or corticosteroids could be used whether there is an underlying thyroid disease or not. Immunotherapies with anti-PD-1/PDL1 or anti-CTLA-4 can also provide dysthyroidism. A monitoring of the thyroid assessment needs to be done in these patients, even if there are no clinical signs, which are not very specific in this context. The treatment of hypothyroidism will be based on thyroid replacement therapy according to the TSH level and the presence or absence of anti-TPO antibodies. Treatment of symptomatic hyperthyroidism may involve a prescription of beta-blockers, or synthetic antithyroid drugs in case of positive anti-TSH receptor antibodies. In all cases, it is desirable to contact an endocrinologist to confirm the diagnosis hypothesis and to decide on a suitable treatment.
Mots clés
Hyperthyroidism, Hyperthyroïdie, Hypothyroidism, Hypothyroïdie, Immunotherapy, Immunothérapie, Iode, Iodine, Thyroiditis, Thyroïdite
Référence
Rev Med Interne. 2020 Feb 24;: