《THYROID DISEASE 》

* 一個 thyroid swelling 的患者 若會thyroid pain tenderness swallowing pain(thyroid area) 要懷疑是 subacute granulomatous thyroditis , acute thyroiditis .
需測 T3,T4, TSH, ESR, CBC/DC.
subacute granulomatous thyroditis: 會hyperthyroidism, higher ESR(>50),T3上升,T4上升, TSH下降, T3/T4 < 20, CBC/DC 正常.
Acute thyroditis: fever usually, euthroid, WBC higher , higher ESR.

* acute thyroiditis: 先以antibiotics 治療 若沒效 則轉彰基ENT 做needle aspiration biopsy + drainage
* subacute granulomatous thyroiditis : 以 NSAID 或 oral steroids 治療. 若有hyperthyroidism 則以inderal 治療.

*一個 thyroid swelling 的患者若不痛,則有可能是 euthyroid nodule, thyroid ca, graves disease, Hashimoto disease, subacute lymphocytic thyroiditis, postpartum throditis.
要抽血測T3,T4,TSH,ESR. 一般而言, 只有 Hashimoto disease才需用到thyroxine, graves disease 才需用到antithyroid agent.
>若graves disease: T3上升,T4上升, TSH下降, T3/T4 > 20,
>若Hashimoto disease, subacute lymphocytic thyroiditis後期(前期,會暫時性的hyperthyroidism且T3/T4< 20,但ESR正常) : T3下降,T4下降, TSH上升. 二者之分需要病史及長期追蹤 後者六個月內就會恢復正常
>若postpartum throditis 可能會hyperthyroid, hypothyroid, 先hyperthyroid, 後 hypothyroid 用病史及長期追蹤 就可獲得答案
>若euthyroid nodule goiter , thyroid ca.: T3,T4,TSH,ESR都正常 可轉彰基頭頸癌科做needle aspiration biopsy 才能區分