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Treatment of Lymphocytic Thyroiditis With Spontaneously Resolving Hyperthyroidism (Silent Thyroiditis)

Treatment of Lymphocytic Thyroiditis With Spontaneously Resolving Hyperthyroidism (Silent... Abstract • The duration of the hyperthyroidism associated with lymphocytic thyroiditis (LT) with spontaneously resolving hyperthyroidism (SRH) was serially monitored in groups of patients who were not given any treatment (control subjects) or treated with propylthiouracil and/or propranolol hydrochloride and prednisone. The length of time for the thyroxine tests from diagnosis to the normal range was 57 ± 17, 45 ± 13, and 15 ± 7 days (mean ± SD) indicating a dramatic response to prednisone therapy but none to propylthiouracil and/or propranolol therapy. Five patients were found who had seven episodes of SRH while receiving thyroid hormone suppression therapy after having verified chronic LT (two patients) and LT-SRH (three patients). This indicates that thyroid suppression with thyroid hormone may be ineffective in preventing this disease. Two patients were treated by subtotal thyroidectomy because of recurrent or prolonged episodes of SRH. From this experience, the therapeutic alternatives available to the clinician are reviewed. Back to top Article Information Accepted for publication Aug 4, 1982. Reprint requests to the Section of Endocrinology, Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449 (Dr Nikolai). References 1. Nikolai TF, Brosseau J, Kettrick MA, et al. Lymphocytic thyroiditis with spontaneously resolving hyperthyroidism (silent thyroiditis). Arch Intern Med. 1980;140:478-482. PubMedGoogle ScholarCrossref 2. Dorfman SG, Cooperman MT, Nelson RL, et al. Painless thyroiditis and transient hyperthyroidism without goiter. Ann Intern Med. 1977;86:24-28. PubMedGoogle ScholarCrossref 3. Morrison J, Caplan RH. Typical and atypical (‘silent’) subacute thyroiditis in a wife and husband. Arch Intern Med. 1978;138:45-48. PubMedGoogle ScholarCrossref 4. Nikolai TF, Coombs GJ, McKenzie AK. Lymphocytic thyroiditis with spontaneously resolving hyperthyroidism and subacute thyroiditis: Long-term follow up. Arch Intern Med. 1981;141:1455-1458. PubMedGoogle ScholarCrossref 5. Papapetrou PD, Jackson IMD. Thyrotoxicosis due to ‘silent’ thyroiditis. Lancet. 1975;1:361-363. PubMedGoogle ScholarCrossref 6. Gluck FB, Nusynowitz ML, Plymate S. Chronic lymphocytic thyroiditis, thyrotoxicosis, and low radioactive iodine uptake: Report of four cases. N Engl J Med. 1975;293:624-628. PubMedGoogle ScholarCrossref 7. Woolf PD, Daly R. Thyrotoxicosis with painless thyroiditis. Am J Med. 1976;60:73-79. PubMedGoogle ScholarCrossref 8. Ginsberg J, Walfish PG. Post-partum transient thyrotoxicosis with painless thyroiditis. Lancet. 1977;1:1125-1128. PubMedGoogle ScholarCrossref 9. Hofeldt FD, Weled BJ, Brown JE, et al. ‘Silent thyroiditis’ versus thyrotoxicosis factitia. Minn Med. 1976;59:380-382. PubMedGoogle Scholar 10. Blonde L, Witkin M, Harris R. Painless subacute thyroiditis simulating Graves' disease. West J Med. 1976;125:75-78. PubMedGoogle Scholar 11. Check JH, Avellino J. Painless thyroiditis and transient thyrotoxicosis after Graves' disease. JAMA. 1980;244:1361. PubMedGoogle ScholarCrossref 12. Parker M, Klein I, Fishman LM, et al. Silent thyrotoxic thyroiditis in association with chronic adrenocortical insufficiency. Arch Intern Med. 1980;140:1108-1109. PubMedGoogle ScholarCrossref 13. Gordon M. ‘Silent’ thyroiditis with symptomatic hyperthyroidism in an elderly patient. J Am Geriatr Soc. 1978;26:375-377. PubMedGoogle ScholarCrossref 14. Shahady EJ, Meckler GM. Postpartum thyroiditis. J Fam Pract. 1980;11:1049-1052. PubMedGoogle Scholar 15. Gorman CA, Duick DS, Woolner LB, et al. Transient hyperthyroidism in patients with lymphocytic thyroiditis. Mayo Clin Proc. 1978;53:359-365. PubMedGoogle Scholar 16. Amino N, Miyai K, Yamamoto T, et al. Transient recurrence of hyperthyroidism after delivery in Graves' disease. J Clin Endocrinol Metabol. 1977;44:130-136. PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Treatment of Lymphocytic Thyroiditis With Spontaneously Resolving Hyperthyroidism (Silent Thyroiditis)

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.142.13.2281
Publisher site
See Article on Publisher Site

Abstract

Abstract • The duration of the hyperthyroidism associated with lymphocytic thyroiditis (LT) with spontaneously resolving hyperthyroidism (SRH) was serially monitored in groups of patients who were not given any treatment (control subjects) or treated with propylthiouracil and/or propranolol hydrochloride and prednisone. The length of time for the thyroxine tests from diagnosis to the normal range was 57 ± 17, 45 ± 13, and 15 ± 7 days (mean ± SD) indicating a dramatic response to prednisone therapy but none to propylthiouracil and/or propranolol therapy. Five patients were found who had seven episodes of SRH while receiving thyroid hormone suppression therapy after having verified chronic LT (two patients) and LT-SRH (three patients). This indicates that thyroid suppression with thyroid hormone may be ineffective in preventing this disease. Two patients were treated by subtotal thyroidectomy because of recurrent or prolonged episodes of SRH. From this experience, the therapeutic alternatives available to the clinician are reviewed. Back to top Article Information Accepted for publication Aug 4, 1982. Reprint requests to the Section of Endocrinology, Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449 (Dr Nikolai). References 1. Nikolai TF, Brosseau J, Kettrick MA, et al. Lymphocytic thyroiditis with spontaneously resolving hyperthyroidism (silent thyroiditis). Arch Intern Med. 1980;140:478-482. PubMedGoogle ScholarCrossref 2. Dorfman SG, Cooperman MT, Nelson RL, et al. Painless thyroiditis and transient hyperthyroidism without goiter. Ann Intern Med. 1977;86:24-28. PubMedGoogle ScholarCrossref 3. Morrison J, Caplan RH. Typical and atypical (‘silent’) subacute thyroiditis in a wife and husband. Arch Intern Med. 1978;138:45-48. PubMedGoogle ScholarCrossref 4. Nikolai TF, Coombs GJ, McKenzie AK. Lymphocytic thyroiditis with spontaneously resolving hyperthyroidism and subacute thyroiditis: Long-term follow up. Arch Intern Med. 1981;141:1455-1458. PubMedGoogle ScholarCrossref 5. Papapetrou PD, Jackson IMD. Thyrotoxicosis due to ‘silent’ thyroiditis. Lancet. 1975;1:361-363. PubMedGoogle ScholarCrossref 6. Gluck FB, Nusynowitz ML, Plymate S. Chronic lymphocytic thyroiditis, thyrotoxicosis, and low radioactive iodine uptake: Report of four cases. N Engl J Med. 1975;293:624-628. PubMedGoogle ScholarCrossref 7. Woolf PD, Daly R. Thyrotoxicosis with painless thyroiditis. Am J Med. 1976;60:73-79. PubMedGoogle ScholarCrossref 8. Ginsberg J, Walfish PG. Post-partum transient thyrotoxicosis with painless thyroiditis. Lancet. 1977;1:1125-1128. PubMedGoogle ScholarCrossref 9. Hofeldt FD, Weled BJ, Brown JE, et al. ‘Silent thyroiditis’ versus thyrotoxicosis factitia. Minn Med. 1976;59:380-382. PubMedGoogle Scholar 10. Blonde L, Witkin M, Harris R. Painless subacute thyroiditis simulating Graves' disease. West J Med. 1976;125:75-78. PubMedGoogle Scholar 11. Check JH, Avellino J. Painless thyroiditis and transient thyrotoxicosis after Graves' disease. JAMA. 1980;244:1361. PubMedGoogle ScholarCrossref 12. Parker M, Klein I, Fishman LM, et al. Silent thyrotoxic thyroiditis in association with chronic adrenocortical insufficiency. Arch Intern Med. 1980;140:1108-1109. PubMedGoogle ScholarCrossref 13. Gordon M. ‘Silent’ thyroiditis with symptomatic hyperthyroidism in an elderly patient. J Am Geriatr Soc. 1978;26:375-377. PubMedGoogle ScholarCrossref 14. Shahady EJ, Meckler GM. Postpartum thyroiditis. J Fam Pract. 1980;11:1049-1052. PubMedGoogle Scholar 15. Gorman CA, Duick DS, Woolner LB, et al. Transient hyperthyroidism in patients with lymphocytic thyroiditis. Mayo Clin Proc. 1978;53:359-365. PubMedGoogle Scholar 16. Amino N, Miyai K, Yamamoto T, et al. Transient recurrence of hyperthyroidism after delivery in Graves' disease. J Clin Endocrinol Metabol. 1977;44:130-136. PubMedGoogle ScholarCrossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Dec 1, 1982

Keywords: hyperthyroidism,thyroiditis, autoimmune,thyroiditis,propylthiouracil,prednisone,thyroid hormones,propranolol,thyroxine measurement,subtotal thyroidectomy,thyroid

References