Amiodarone Induced Thyroiditis, with this
it could be… patient may present either
with hypo or hyperthyroidism, structure resembled
that of your thyroid hormone because it contains
iodine, seen in approximately 3 percent of
amiodarone, 1 to 3 years of therapy, thyroid
is not enlarged or tender, can cause both
hypo and/or hyperthyroidism.
Hypothyroidism by blocking the peripheral
conversion of T4 to T3, hyperthyroidism because
literally the thyroid feels as though that
it is increasing its uptake of iodine.
Low blood flow on color flow Doppler thyroid
ultrasound is what you are thinking of in
general with thyroiditis.
Take a look at Riedel.
With Riedel’s thyroiditis, we called this
It is a primary fibrosing disorder, if you
then take a look at the picture on the right.
On the far right, a remnant of or sparing
of a little bit of your thyroid histology
whereas on the left, you are seeing quite
a bit of fibrosis taking place of your thyroid
So, now, two different things that are taking
place in a thyroid gland, earlier referred
to granulomatous and that would be more or
less your subacute type, maybe viral infection
and with viral infection, you are thinking
about painless or painful, excuse me, whereas
if it is painless and a silent lymphocytic
infiltration, this is primary fibrous in disorder.
Women, much more so than men, elderly, dense
fibrosis, that replaces the normal thyroid
parenchyma with macrophage and eosinophil
Fibrosis, once again, take a look at the picture
histologically on your left, would be areas
of that fibrosis which is then replacing any
type of thyroid normal tissue that may exist.
Meaning to say, the far right in that homogenous
pink region represents your colloid.
The fibrosis invades the adjacent structures
and that is important for you to pay attention
to of the neck and extends beyond the thyroid
So, therefore, now, you are thinking about
other areas adjacent such as the esophagus
that might be affected, may present therefore
Hard, woody gland treat surgery if compressive
Like I told you earlier, that fibrosis can
be quite dangerous especially if it starts
growing and therefore, causing fibrosis of
perhaps behind it; you are thinking about
the trachea or perhaps even the esophagus,
dysphagia and dyspnea.
Then we have multinodular goiter.
With multinodular goiter, you are thinking
about a patient who is a little bit older
and if you were to take a look at the neck,
this is a thyroid gland in which it has numerous
nodules throughout the thyroid gland causing
this diffused enlargement of the neck.
The gross pathology here would be the multinodular
goiter with huge cystic nodules with excessive
Hemorrhage has occurred and could occur because
whenever you have a cyst and it keeps enlarging,
there might be every possibility of rupture
of a blood vessel or capillary.
Therefore, blood then hemorrhaging into your
cyst itself, multinodular goiter.
So, how do you want to take care of your toxic
First, while you have toxic multinodular and
solitary toxic adenoma known as Plummer’s
disease are overall less frequent than Graves’
disease, but in terms of presentation may
present more so with hyperthyroidism.
Who is your patient with multinodular or toxic
adenoma of the thyroid?
These patients are almost always elderly,
Remission, not seen with antithyroid drugs;
radioactive iodine is a treatment of choice;
through surgery is a reasonable option but
once again, when you get in here and therefore,
you want to ablate, ablate your thyroid.
Your surgery would only be considered if your
patient is now suffering from the constructive
effects of that goiter enlargement, dysphagia,
dyspnea or perhaps hoarseness.