Subacute thyroiditis in children

Introduction to subacute thyroiditis in children Subacute thyroiditis is a non-suppurative inflammatory disease, with thyroid inflammatory damage, tissue damage to complete recovery, clinical manifestations and changes in thyroid function, that is, hyperthyroidism hypothyroidism normal thyroid function. More common in adults, children are rare, this disease is a self-limiting disease, the course of disease weeks to months. basic knowledge The proportion of illness: 0.0005% Susceptible people: children Mode of infection: non-infectious Complications: hyperthyroidism

The cause of subacute thyroiditis in children

(1) Causes of the disease

The disease is a thyroid non-suppurative infectious disease, also known as De Quervain disease, the cause has not been fully elucidated so far, is non-specific, it is currently believed that this disease may be related to viral infection, often occurs 2 to 3 weeks after viral infection, such as the parotid gland Inflammatory virus, subacute thyroiditis often has a high incidence during the epidemic of mumps. Mumps virus has been isolated from thyroid tissue in 2 patients, and 10 of 11 patients have positive anti-mumps virus antibody titers in vivo. It is an immunoreactive disease after viral infection. Pediatrics has reported that it has developed into a hypothyroidism following this disease. The HLA-BW35 genotype has been reported to be associated with subacute thyroiditis, as well as Echo virus, Coxsackie virus, etc. Reporting thyroid trauma and radiation damage can also lead to this disease, which is a painless variant that can be acute, subacute, and occasionally chronic.

(two) pathogenesis

The lesioned thyroid is obviously enlarged, most of which are affected by one leaf or two leaves. The main manifestations are edema, congestion, hard texture, and the boundary between normal thyroid tissue is not obvious. The pathological section is subacute and chronic inflammation, the most typical There is granulation tissue formation around the degenerating thyroid follicle, and there are giant cells inside. The late changes of this disease are similar to chronic thyroiditis. There are more fibrous tissues in the gland and the texture is hard.

Prevention of subacute thyroiditis in children

Actively prevent all kinds of infectious diseases, do a good job in vaccination, pay attention to personal hygiene and environmental sanitation, prevent respiratory diseases, pay attention to indoor air fresh, reasonable nutrition, and enhance physical fitness.

1. Pay attention to personal and environmental hygiene.

2, pay attention to indoor air fresh, reasonable nutrition, suitable for outdoor sports in order to enhance personal physique.

3. Do a good job in vaccination to prevent various infectious diseases and respiratory infections.

Pediatric subacute thyroiditis complications Complications

In the extreme stage of the disease, there may be hyperthyroidism, the thyroid may be nodular, and a small number may appear hypothyroidism.

Pediatric subacute thyroid symptoms common symptoms low fever, high fever, fatigue, irritability, palpitations, thyroid swelling, thyroid function, hyperthyroidism, sore throat

Slow onset, typical cases can have a history of prodromal disease, sore throat, fatigue, weakness, neck pressure, this stage is easy to miss diagnosis, the disease is further developed, there is a systemic high fever 40 ° C, chills, thyroid swelling, accompanied by pain and tenderness Can be radiated to the back of the neck, behind the ear, mandible, neck activity can cause pain, heavy affects swallowing, the disease can also have hyperthyroidism, such as palpitations, sweating, irritability, swollen thyroid gland The surface is smooth, the texture is hard, and occasionally the thyroid gland is nodular, the course of the disease is generally 2 to 3 months, the length is up to 1 year, can be relieved by itself, a small amount of hypothyroidism, early decline of blood TSH, normal later or Slightly higher, good response to prednisone treatment, plus local thyroid pain is often characteristic of this disease, and can be distinguished from acute suppurative thyroiditis.

Atypical cases only have local enlargement of the thyroid gland, but no systemic symptoms, only low fever, thyroid tenderness is not obvious, and sometimes the thyroid gland and surrounding tissues can be seen in surgery, which is difficult to distinguish from thyroid cancer.

Examination of subacute thyroiditis in children

Laboratory inspection

1. General blood examination: There is no increase or slight increase in white blood cells in the blood. Due to the influence of chronic infection, there may be anemia, and the blood sedimentation will increase rapidly. The course of disease can reach 40-70mm/h within 1 month.

2. Thyroid function test: T3, T4 increased is not obvious, acute phase iodide tyrosine and iodinated protein increased; TSH and absorbing 131 I rate is very low or no, during this period T4, T3 decreased to the normal range.

3. Suction 131I rate: It can be very low, such as stimulation of exogenous TSH does not increase its absorption rate, because thyroid function is reduced during inflammation, which stimulates high secretion of TSH.

4. Immune function test: Subacute thyroiditis plasma protein abnormalities, 2-globulin increased, recently reported serum C4 and C3 decreased, contrary to blood C3, IgM, --globulin and a-1 antitrypsin increased .

Film degree exam

1. Thyroid ultrasonography and scanning: visible thyroid enlargement, occasionally nodular enlargement, showing thyroid substantial occupying lesions or "nodule is a low-density lesion", ECT imaging for thyroid radioactive distribution sparse or cold Nodule.

2. Electrocardiogram examination: Electrocardiogram examination showed sinus tachycardia when hyperthyroidism occurred.

Diagnosis and diagnosis of subacute thyroiditis in children

diagnosis

Typical cases can be diagnosed according to medical history, clinical symptoms and laboratory tests. For children with thyroid enlargement, obvious pain and tenderness in the swollen area, history of fatigue, general malaise or respiratory infection, subacute thyroiditis may be considered. Laboratory tests revealed that serum thyroid hormone levels were separated from RAIU (ie, serum T3, T4 was elevated, TSH was suppressed, and RAIU was decreased), erythrocyte sedimentation rate was significantly increased, and diagnosis was established.

Staging diagnosis: subacute thyroiditis can be divided into acute phase and recovery phase after several weeks to several months.

1. Acute phase: Iodine tyrosine and iodinated protein increased from 2 to 6 weeks, TSH and 131 I rate were low or absent. During this period, T4 and T3 decreased to the normal range, and the goiter increased and was hard. TSH does not respond to TRH.

2. Recovery period: There may be thyroid dysfunction such as increased TSH, blood T4 decreased, 131I rate returned to normal, thyroid function decreased from 2 weeks to 7 months after the disease, then the size of the thyroid, the hardness returned to normal, anti- The increase in thyroglobulin antibodies can be reduced to normal within a few weeks after onset, and transient thyroid antibodies may be elevated.

Differential diagnosis

Early cases should be differentiated from certain fever-recognized diseases. First, the understanding of the disease should be improved. The mid-term should be differentiated from lymphatic thyroiditis and thyroid cyst hemorrhage. The advanced cases should be differentiated from thyroid cancer and fibrotic thyroiditis. Tissue biopsy confirms the diagnosis.

In addition, it needs to be differentiated from CLT, Graves disease and AST, according to whether the thyroid has pain, thyroid function status, and RAIU detection of autoantibodies. However, in the later stage of the disease, the identification is more difficult, and the thyroid autoantibodies are significantly elevated. Possibly; sometimes it is necessary to wait until the goiter and thyroid dysfunction disappear to make a SAT diagnosis. If the child has non-pain mild goiter, no fatigue and other general malaise, laboratory tests find that serum thyroid hormone is separated from RAIU, erythrocyte sedimentation The rate is normal or slightly elevated, and painless SAT should be considered. This type of SAT serum TGA is often positive, and may be associated with hyperthyroidism, so it should be differentiated from CLT and Graves disease.

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