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oid treatment may be added for partial alleviation of pain and compression symptoms Surgical decompression usually fails to permanently alleviate compression symptoms; such surgery is difficult due to dense fibrous adhesions, making surgical complications more likely

In subacute thyroiditis, spontaneous remissions and exacerbations are common, and therapy is supportive; the disease process may smolder for months Hashimoto s thyroiditis is occasionally associated with other autoimmune disorders (diabetes mellitus, Addison s disease, pernicious anemia, etc) In general, however, patients with Hashimoto s thyroiditis have an excellent prognosis, since the condition either remains stable for years or progresses slowly to hypothyroidism, which is easily treated Women with postpartum thyroiditis usually regain normal thyroid function Papillary thyroid carcinoma carries a relatively good prognosis when it occurs in patients with Hashimoto s thyroiditis

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Gullu S et al In vivo and in vitro effects of statins on lymphocytes in patients with Hashimoto s thyroiditis Eur J Endocrinol 2005 Jul;153(1):41 8 [PMID: 15994744] Jung YJ et al A case of Riedel s thyroiditis treated with tamoxifen: another successful outcome Endocr Pract 2004 Nov Dec;10(6):483 6 [PMID: 16033720] Pearce EN et al Thyroiditis N Engl J Med 2003 Jun 26;348(26): 2646 55 [PMID: 12826640] Smyth PP et al Sequential studies on thyroid antibodies during pregnancy Thyroid 2005 May;15(5):474 7 [PMID: 15929669] Stagnaro-Green A Postpartum thyroiditis Best Pract Res Clin Endocrinol Metab 2004 Jun;18(2):303 16 [PMID: 15157842]

about 50% palpable solitary nodules are found to be just one nodule in a multinodular goiter About 95% of thyroid nodules are benign, but the presence of a thyroid nodule warrants follow-up and further testing for function and malignancy Most patients with a thyroid nodule are euthyroid, but there is a high incidence of hypothyroidism or hyperthyroidism Goiter may be caused by numerous conditions, including multinodular goiter, iodine deficiency, pregnancy (in areas of iodine deficiency), Graves disease, Hashimoto s thyroiditis, subacute thyroiditis, or infections About 95% of thyroid nodules are benign adenoma, colloid nodule, or cyst but may sometimes be a primary thyroid malignancy or (less frequently) a metastatic neoplasm Patients with multiple thyroid nodules have the same overall risk of thyroid cancer as patients with solitary nodules The risk of a thyroid nodule being malignant is higher among patients with a history of head neck radiation, a family history of thyroid cancer, or a personal history of another malignancy The risk of malignancy is also higher if a thyroid nodule is large, adherent to the trachea or strap muscles, or associated with lymphadenopathy The presence of Hashimoto s thyroiditis does not reduce the risk of malignancy; a nodule of 1 cm in a gland with thyroiditis carries an 8% chance of malignancy

Table 26 6 illustrates the approach to the evaluation of thyroid nodules based on the index of suspicion for malignancy

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Most small thyroid nodules cause no symptoms and are easy to miss during routine physical examinations Such small thyroid nodules may sometimes be detected only by having the patient swallow during careful inspection and palpation of the thyroid A thyroid nodule or multinodular goiter can grow to become visible and of concern to the patient Particularly large nodular goiters can become a cosmetic embarrassment Nodules can grow large enough to cause discomfort, hoarseness, or dysphagia Retrosternal large multinodular goiters can cause dyspnea due to tracheal compression Large substernal goiters may cause superior vena cava syndrome, manifested by facial erythema and jugular vein distention that progress to cyanosis and facial edema when both arms are kept raised over the head (Pemberton s sign) Depending on their cause, goiters and thyroid nodules may be associated with hypothyroidism (Hashimoto s thyroiditis, endemic goiter) or hyperthyroidism (Graves disease, toxic nodular goiter, subacute thyroiditis, and thyroid cancer with metastases)

Single or multiple thyroid nodules are commonly found with careful thyroid examinations Thyroid function tests mandatory Thyroid biopsy for single or dominant nodules or for a history of prior head neck or chest shoulder radiation Ultrasound examination useful for biopsy and follow-up Clinical follow-up required

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