Tiroidite subacuta
La tiroidite subacuta o tiroide di De Quervain è un’ infiammazione della tiroide di probabile origine virale.
Numerosi virus, quali quelli della parotite, virus influenzali, adenovirus e virus Coxsackie, sono stati ritenuti responsabili di tale affezione. Macroscopicamente la tiroide risulta di dimensioni aumentate, mentre l’esame istologico dimostra distruzione dei follicoli e comparsa di istiociti e cellule giganti. Si tratta pertanto
di una tiroide distruttiva con conseguente fase iniziale di tireotossicosi da liberazione degli ormoni tiroidei immagazzinati nei follicoli e successiva fase di ipotiroidismo, nel caso in cui il processo distruttivo abbia interessato una grossa porzione di ghiandola.
Quadro clinico
La tiroidite subacuta si manifesta in genere con un esordio brusco, febbre, malessere generale, dolori intensi alla regione tiroidea che si accentua con la tosse, deglutizione e l’estensione del collo, generalmente preceduta da faringite o laringite. Il dolore è tipicamente irradiato verso l’orecchio e migrante da un luogo all’altro. Sono presenti spesso segni di lieve tireotossicosi, quali:
– tremori – agitazione – sudorazione. La tiroide è generalmente ingrandita e dolenti alla palpazione. Questa patologia è frequentemente recidivante.
Diagnosi
La diagnosi si basa sui seguenti elementi:
– quadro clinico;
– esami biochimici: aumento Ves e PCR, leucocitosi;
– esami di funzionalità tiroidea: fase iniziale di tireotossicosi, generalmente con TSH soppresso e ormoni tiroidei liberi nella norma; frequentte positivizzazione degli autoanticorpi antitiroide nella fase iniziale. Con la guarigione, la funzione tiroidea ritorna nella norma, con negativizzazione degli autoanticorpi, ma in molti casi l’esito è l’ipotiroidismo;
– scintigrafia tiroidea: patognomonica è l’assenza di captazione
per la distruzione follicolare e la soppressione del TSH. Questo consente di porre diagnosi differenziale tra questa forma di tireotossicosi e ipertiroidismo primitivo, che si associa a ipercaptazione.
– ecografia tiroidea: anche il quadro ecografico è caratteristico con area di ipoecogenicità definito “a zolle” e corrispondenti alle zone di maggiore dolorabilità.
Terapia
Il trattamento si basa sull’impiego di antinfiammatori nelle forme più lievi e di cortisonici nelle forme più marcate o recidivanti.
Può essere utilizzato il Deltacortene a dosaggio iniziale di 25/50 mg con dosi scalari per una durata per ogni ciclo di trattamento di 2 mesi circa. Una settimana dalla sospensione del trattamento, vanno rivalutati funzione tiroidea, indici infiammatori ed ecografia.
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