Signs of thyroiditis of the thyroid gland in women. Thyroiditis symptoms and treatment. Acute thyroiditis - treatment

What it is?

AIT, autoimmune thyroiditis thyroid gland– this is one of the forms of organ-specific pathologies of autoimmune genesis, characterized by inflammatory processes in the thyroid gland, causing lymphoid infiltration and destruction of the follicular tissues of the organ.

The disease has a hundred-year history and was first described by the Japanese surgeon Hashimoto. Subsequently, pathology began to be called after him -
"goiter or Hashimoto's thyroiditis."

Mostly women of mature age (45-60 years) are susceptible to the disease, which is due to an X-chromosomal disorder and the estrogenic effect on the cells of the lymphoid system involved in the immune response mechanism. In some cases it affects young people and children. Autoimmune thyroiditis occurs in more than 20% of pregnant women.

About causes and development

The genesis of the development of AIT is due to the phagocytic aggression of the immune system towards thyroid tissues, perceiving them as a foreign “agent” and producing antibodies to them. This fact causes autoimmune processes of inflammation and destruction of organ cells, including those producing hormones.

This explains the development of autoimmune thyroiditis, hypothyroidism and thyrotoxicosis, when there is a decrease or increase in hormonal synthesis. Among other things, autoimmune inflammatory processes in the tissues of the thyroid gland give impetus to the development of nodular neoplasms in them.

Autoimmune thyroiditis is classified as a genetically inherited disease, which is often confirmed by the presence of pathology in relatives close to the patient. But genetic predisposition not the only cause of AIT. Trigger phagocytic failure and hormonal dysfunction can:

frequent pathologies of a viral and bacterial nature;
chronic ENT infections;
harmful environmental factors, provoking an increase in immune activity;
excessive exposure to radiation and UV radiation;
long-term uncontrolled use of hormones and iodine-containing drugs;
iodine deficiency in the body;
periods of hormonal changes;
immune failure and predisposition to allergies
surgical interventions on the thyroid gland and injuries;
nervous pathologies and stress.

Such patients are often accompanied by others autoimmune diseases– diffuse processes in the thyroid gland ( Graves' disease), development of asthenic bulbar palsy(myasthenia gravis), endocrine Graves' ophthalmopathy, damage to the lacrimal and salivary glands due to “dry syndrome” of Shagren, collagenosis (connective tissue pathology), diffuse proliferation of lymphoid cells (lymphoid hypophysitis).

Symptoms of autoimmune thyroiditis by form

AIT has various variations, the genesis of all its types has the same nature of development, according to the type of aseptic inflammatory process, gradually taking the form of transient (transient) hypothyroidism. Manifests:

Autoimmune chronic thyroiditis is a consequence of immune phagocytic aggression, leading to destructive changes in the thyroid gland and causing development hypothyroidism.
Postpartum thyroiditis, developing as a result excessive activity phagocytic protection during pregnancy. In pregnant women predisposed to endocrine disorders, this type of pathology can subsequently transform into chronic autoimmune thyroiditis.
The type of painless thyroiditis (silent) is similar to the manifestation of postpartum thyroiditis, but the genesis is not associated with pregnancy.
A cytokine-induced type of disease develops in patients who have been exposed to Interferon therapy for a long time, with blood diseases and hepatitis C.

Clinical signs of disorders in thyroid gland determined by the form of AIT flow:

Hypertrophic, characterized by a uniform increase in the entire thyroid gland or with signs of nodular formations. The functions of the gland are not impaired, or are slightly reduced. IN initial period thyrotoxicosis is possible. The progression of the autoimmune process leads to decreased function, deterioration of the condition and the development of hypothyroidism.
Atrophic, most severe form autoimmune thyroiditis, provoked by an extensive process of destruction of the follicular cells of the thyroid gland, sharply reducing its functions.

The AIT clinic is distinguished by a four-phase course of the disease: euthyroid, subclinical, thyrotoxic and hypothyroid, which replace each other and can last for years.

Autoimmune thyroiditis is characterized by a slow development of symptoms. Often the pathological process can be asymptomatic or with mild symptoms, which is characteristic of the euthyroid and subclinical phase. Thyroid cells are affected slightly and specially functional disorders no organ is noted. This course of the disease can last for decades.

Only slight discomfort may be felt in the thyroid area, in the form of a lump pressing on the throat, mild fatigue and weakness, and pain in the joints.

Main symptom autoimmune thyroiditis – growth of colloid goiter. The remaining signs are a reflection of a disturbance in the process of hormonal synthesis, its decrease or increase - hypothyroidism or hyperthyroidism (thyrotoxicosis). The clinical picture of thyrotoxicosis is usually observed in the first few years of development of the pathology.

As atrophic processes develop in the tissues of the thyroid gland, it is marked by a temporary transition into the ethyroid phase, followed by a transition to the hypothyroidism phase.

Steady increase hormonal levels(with thyrotoxicosis) manifests itself:

slight low-grade fever of the body;
cardiac arrhythmia and hyperhidrosis;
spontaneous shortness of breath, without the influence of stress;
tremors in the limbs and weight loss;
insomnia (insomnia) and neuroses (hysteria, irritability).

The hypothyroid phase of AIT is called the final phase, caused by the cellular destruction of most of the thyroid gland and insufficient hormonal synthesis by the remaining undamaged cells. Typical symptoms of decreased hormonal levels (hypothyroidism):

chronic fatigue;
significant weight gain;
hypothermia ( low temperature) and swelling;
coarse facial features;
diction defects, slowness and drowsiness;
disruptions in the menstrual cycle, signs of libido and infertility.

Treatment of autoimmune thyroiditis, drugs

The disease is diagnosed by palpation and ultrasound examination of the thyroid gland. Deviations of a serious nature are expressed by difficulties in swallowing and breathing caused by compression of adjacent organs. Changes in blood counts are noted due to inflammatory reactions in the thyroid tissues. Immunogram indicators help determine elevated or reduced level hormones. Diagnostic criterion – increased level and aggression of antibodies in the thyroid gland - AT-TPO.

Most of the symptoms are characteristic of various pathological processes, which do not overlap with AIT, so appropriate differential diagnosis is carried out.

There is no clear treatment regimen for autoimmune thyroiditis. The therapeutic effect is aimed at relieving the symptoms of the disease depending on the phase of its course - thyrotoxic or hypothyroid. Includes:

Hormone replacement therapy.
Suppressive therapy hormonal function thyroid gland
If the organ is greatly enlarged, surgical intervention is required.

For AIT with signs of hypothyroidism, it is prescribed conservative therapy the drug “Levothyroxine”, “Mercazolil”, “Tiamazole”, and adrenergic drugs “Alpha-blockers”, aimed at hormonal regulation.

If the process has acute course glucocorticosteroid drugs are added - for example, Prednisolone. To reduce the aggression of antibodies to thyroid tissues, anti-inflammatory drugs are prescribed non-steroidal drugs– “Voltaren”, “Indomethacin”, and others.

AIT - treatment with Endorm

The therapeutic complex also includes the treatment of autoimmune thyroiditis with Endorm. A drug is prescribed to weaken the attack of antibodies and replenish the thyroid tissue with macro and microelements. Homeopathic supplements included in the drug help restore the functioning of the adrenal glands and glands of the reproductive system, damaged due to hormonal imbalance.

Adaptogen preparations are also used to help the body adapt to harmful effects, vitamin complexes and immunomodulatory therapy.

The worst thing that can be expected from autoimmune thyroiditis is the development of autoimmune diffuse processes in various organs and body systems indicating deep damage to the endocrine system.

Possible consequences

The consequences of autoimmune thyroiditis are rare and only in those cases where adequate treatment was not carried out.

Among adult patients may progress mental disorders caused by depressive syndrome. Manifest as a syndrome of decreased and underdeveloped intelligence. Development of heart and vascular diseases.
IN childhood manifest itself as underdevelopment of the organs of the reproductive system, mental retardation and mental development, up to idiocy and pituitary dwarfism (dwarfism).
The consequences of autoimmune thyroiditis in pregnant women can result in signs of gestosis, placental insufficiency and early termination of pregnancy.

Autoimmune thyroiditis cannot be cured completely. The patient will have to depend on supportive care for life. Timely diagnosis and correctly selected treatment will provide full life and get rid of possible complications. Save reproductive functions And physical activity, will help achieve stable and long-term remission for many years.

This disease is more common in people aged 30 to 50 years. Women, unfortunately, are more susceptible to autoimmune thyroiditis.

Autoimmune thyroiditis: symptoms and treatment

Autoimmune thyroiditis (AIT) is an autoimmune disease and the main cause of hypothyroidism.

This disease causes significant inflammation of the thyroid gland, which leads to low production of its hormones and gradually - to hypothyroidism.

AIT is called an autoimmune disease because the immune system produces antibodies that attack thyroid tissue.

Traditional medicine does not treat autoimmune thyroiditis, but treatment with folk remedies may well help some people completely get rid of this disease or at least improve the condition and prolong life.

This disease is more common in people aged 30 to 50 years. Women, unfortunately, are more susceptible to autoimmune thyroiditis.

Symptoms of AIT may vary depending on the stage of the disease.

Symptoms of autoimmune thyroiditis in the early stages:

weight gain

fatigue

joint pain

muscle pain

cold intolerance

pale skin

brittle nails

hair thinning

constipation

depression

Symptoms of autoimmune thyroiditis in the later stages:

decreased sense of taste and smell

swelling of the face, arms and legs

a sore throat

dry skin

irregular periods

eyebrow loss

slow speech

Symptoms that can be observed at different stages of AIT:

loss of appetite

swelling in other parts of the body

drowsiness

hair loss

joint stiffness

dry hair

decreased coordination of body movements

muscle atrophy, pain and cramps

In medicine, it is prescribed for the treatment of hypothyroidism hormone replacement therapy – Patients take synthetic thyroid hormones for the rest of their lives. This is due to the fact that over time the thyroid gland produces less and less hormones T4 and T3, which the body desperately needs.

Diagnostic procedures for detecting hypothyroidism are often unreliable, and multiple consecutive tests often produce different results. This is why some people start taking hormonal medications for a condition that they don't actually have until they start the medication regimen.

People who take pharmaceutical hormones are much more difficult to treat than those who do not start taking them or those who immediately start using traditional medicine.

There are many ways to control the symptoms of autoimmune thyroiditis naturally. Many folk remedies can help those who suffer from this disease.

Coconut oil is one of the most powerful healers in the world of natural remedies. If you suffer from autoimmune thyroiditis or hypothyroidism, enriching your daily diet with coconut oil will be one of the best things you can do for your body.

Treatment of autoimmune thyroiditis with coconut oil

Coconut oil is a saturated fat that is primarily composed of medium-chain fatty acids. These fatty acids in oil are known as medium chain triglycerides (MCTs). These medium chain fatty acids help speed up your metabolism, increase your basal body temperature, reduce weight, and increase energy.

Lauric acid makes up more than 50% of MCTs. It is an essential fatty acid and is used by your body to build and maintain the immune system. All these factors together have a positive effect on the thyroid gland.

There are several other equally important fatty acids present in coconut oil that help maintain a high level of health in the body. Linoleic acid- a polyunsaturated fatty acid, which is one of the main products used in the production of weight loss products, sold in capsules as a dietary supplement called conjugated linoleic acid (CLA). This "good" fat has been found in several clinical studies to help reduce fat mass.

Another important connection is oleic acid, which is an omega-9 unsaturated fatty acid. Apart from coconut oil, this acid is also the main compound in olive oil, which is also very beneficial to consume for autoimmune thyroiditis. It has been found that this acid increases the level of high-density lipoprotein (HDL - "good cholesterol") and at the same time reduces the level of low-density lipoprotein (LDL - "bad cholesterol").

If you have autoimmune thyroiditis or hypothyroidism, you should consume at least 4 tablespoons of coconut oil per day. This may seem like a lot of coconut oil to you, but it really isn't.

With autoimmune thyroiditis and hypothyroidism, special attention must be paid to your diet.

Other folk remedies for the treatment of autoimmune thyroiditis

The following folk remedies can also help you improve your condition and reduce the symptoms of autoimmune thyroiditis.

Essential oils

Essential oils can help you in the treatment of autoimmune thyroiditis and hypothyroidism:

myrtle,
myrrh,
peppermint,
spearmint,
carnations.

You can apply them directly to your skin or inhale their vapors using an essential oil diffuser.

Bach flowers

This is a flower essence treatment that is used to control many of the symptoms of autoimmune thyroiditis and hypothyroidism. The following three essences are the most effective in treating patients with autoimmune thyroiditis.

Wild Rose. Take two drops of wild rose essence and mix them in water. Drink this water throughout the day. This remedy relieves fatigue and depression associated with autoimmune thyroiditis.

Elm. Take two drops of elm essence and mix them in water. Drink this water throughout the day. This remedy helps restore health in cases of autoimmune thyroiditis.

Wild apple tree. Take two drops of wild apple essence and mix it in water. Drink this water throughout the day to cleanse your body.

Milk thistle tea

Milk thistle tea is known for its powerful detoxifying properties. You can drink a cup of this tea daily to help your body eliminate toxins.

Pears and apples

The ancient Chinese discovered that pears were a powerful natural remedy for balancing hormones, especially in women. Pears help normalize hormonal levels well if consumed together with apples (you can make pear-apple puree or pear-apple juice). published

The materials are for informational purposes only. Remember, self-medication is life-threatening, seek advice regarding the use of any medicines and treatment options, consult your doctor.

Thyroiditis of the thyroid gland is the most common endocrine disease; in the early stages there may be no symptoms, but it almost always ends. The functions of all organs and systems are impaired, and a person ages quickly. The disease is increasingly being found in children and adolescents; it has a rapid malignant development.

The most common endocrine disease is thyroiditis of the thyroid gland.

What is thyroiditis of the thyroid gland

This term refers to a number of pathological conditions in which it is observed. The most common is. As thyroiditis develops, the functions of the thyroid gland are impaired. The patient requires constant use of hormonal medications.

Causes of thyroiditis

The development of chronic thyroiditis is promoted by autoimmune aggression. The immune system produces antibodies that destroy healthy cells.

tachycardia;

hyperhidrosis;

increased fatigue;

pain in muscles and joints;

dyspnea.

Symptoms persist for several months. The subacute form of thyroiditis ends with recovery and restoration of thyroid function.

Diagnosis of thyroiditis

It is almost impossible to detect thyroiditis in the early stages. The diagnosis is made based on existing symptoms and test results. The presence of such disorders in the patient's relatives increases the likelihood of thyroiditis. The examination includes: general analysis blood, immunogram, level determination and. An increase in TSH with a normal amount of T4 indicates latent hypothyroidism.

Ultrasound of the thyroid gland reveals changes in its size and structure, and the presence of compactions.

The results of this procedure complement the clinical picture and laboratory tests. Fine-needle testing allows you to detect an increase in the number of lymphocytes and other cells that appear during the inflammatory process. Most often prescribed for suspected.

Diagnostic signs of thyroiditis are:

increase in the number of AT-TPO antibodies;

the presence of hypoechoic inclusions in tissues;

symptoms of hypothyroidism.

In the absence of even one criterion, the diagnosis is considered unspecified. Treatment is indicated if there are signs of severe hypothyroidism.

Kinds

There are several forms of thyroiditis, differing in the nature of the clinical picture and the speed of development.

Acute inflammation of the thyroid gland occurs when an infectious agent enters the blood and lymph from nearby organs.

This is observed in chronic and acute tonsillitis and pneumonia. The causative agents of the infection are staphylococci and streptococci. The aseptic form of inflammation occurs due to injuries, exposure to radiation, and hemorrhage in the tissue. In this case, pathogenic microorganisms are not detected.

Treatment of thyroiditis

No specific therapeutic regimens have been developed. Despite the rapid development of medicine, endocrinology does not have safe and effective methods for correcting such abnormalities of the thyroid gland. If there are severe signs of heart failure, beta-blockers are used.

For hypothyroidism, maintenance therapy is prescribed to compensate for the lack of hormones in the body. During this procedure, it is necessary to regularly take a TSH level test.

Diet

There are no special diets for patients with thyroiditis. To restore normal functioning of the thyroid gland, you need to eat 3-4 times a day. A lack of calories will have a bad effect on the patient's condition.

– inflammatory damage to the thyroid gland of an acute, subacute, chronic, autoimmune nature. It manifests itself as a feeling of pressure, pain in the neck, difficulty swallowing, and hoarseness. In acute inflammation, an abscess may form. The progression of the disease causes diffuse changes in the gland and disruption of its functions: initially the phenomenon of hyperthyroidism, and subsequently hypothyroidism, requiring appropriate treatment. Depending on the clinical characteristics and course, acute, subacute and chronic thyroiditis is distinguished; by etiology - autoimmune, syphilitic, tuberculosis, etc.

ICD-10

E06

General information

Thyroiditis may be based on different mechanisms and causes, but the entire group of diseases is united by the presence of an inflammatory component that affects the thyroid tissue.

Classification of thyroiditis

In its practice, clinical endocrinology uses a classification of thyroiditis based on the characteristics of the mechanism of their development and clinical manifestation. There are the following forms of thyroiditis: acute, subacute and chronic. Acute thyroiditis can spread to an entire lobe or the entire thyroid gland (diffuse) or occur with partial damage to a lobe of the gland (focal). In addition, inflammation in acute thyroiditis can be purulent or non-purulent.

Symptoms of thyroiditis

Acute thyroiditis

In purulent form acute thyroiditis inflammatory infiltration of the thyroid gland is observed, followed by the formation of an abscess (abscess) in it. The zone of purulent fusion is excluded from secretory activity, but more often it covers a small part of the gland tissue and does not cause sudden disturbances in hormonal secretion.

Purulent thyroiditis develops acutely - with high fever (up to 40°C) and chills. There are sharp pains on the front surface of the neck with displacement to the back of the head, jaws, tongue, ears, aggravated by coughing, swallowing and head movements. Intoxication is rapidly increasing: severe weakness, fatigue, aches in muscles and joints, headache, and tachycardia appear. Often the patient’s condition is assessed as serious.

Palpation reveals local or diffuse enlargement of the thyroid gland, sharp pain, dense (at the stage of infiltrative inflammation) or softened (at the stage of purulent melting and abscess formation) consistency. There is hyperemia of the skin of the neck, a local increase in temperature, enlargement and tenderness of the cervical lymph nodes. The non-purulent form of acute thyroiditis is characterized by aseptic inflammation of the thyroid tissue and occurs with less severe symptoms.

Subacute thyroiditis

The course of subacute thyroiditis may have pronounced signs of inflammation: febrile body temperature (38°C and above), pain in the anterior surface of the neck radiating to the jaw, back of the head, ear, weakness, increasing intoxication. However, more often the development of the disease is gradual and begins with malaise, discomfort, moderate pain and swelling in the thyroid gland, especially when swallowing, bending and turning the head. The pain intensifies when chewing solid food. Palpation of the thyroid gland usually reveals enlargement and tenderness of one of its lobes. Adjacent lymph nodes are not enlarged.

Subacute thyroiditis in half of the patients is accompanied by the development of mild or moderate thyrotoxicosis. Patient complaints are related to sweating, palpitations, tremors, weakness, insomnia, nervousness, heat intolerance, and joint pain.

Excessive amounts of thyroid hormones (thyroxine and triiodothyronine) secreted by the gland have an inhibitory effect on the hypothalamus and reduce the production of the hormone-regulator thyrotropin. In conditions of thyrotropin deficiency, there is a decrease in the function of the unchanged part of the thyroid gland and the development of hypothyroidism in the second phase of subacute thyroiditis. Hypothyroidism usually does not last long and is not severe, and with the attenuation of inflammation, the level of thyroid hormones returns to normal.

The duration of the stage of thyrotoxicosis (acute, initial) with subacute thyroiditis is from 4 to 8 weeks. During this period, pain in the thyroid gland and neck, a decrease in the accumulation of radioactive iodine in the gland, and the phenomenon of thyrotoxicosis are noted. During the acute stage, thyroid hormone reserves are depleted. As the flow of hormones into the blood decreases, the stage of euthyroidism develops, characterized by normal levels of thyroid hormones.

In cases of severe thyroiditis, with a marked decrease in the number of functioning thyrocytes and depletion of the reserve of thyroid hormones, the stage of hypothyroidism with its clinical and biochemical manifestations may develop. The course of subacute thyroiditis ends with the recovery stage, during which the structure and secretory function of the thyroid gland are finally restored. The development of persistent hypothyroidism is rare; in almost all patients who have suffered subacute thyroiditis, the function of the thyroid gland is normalized (euthyroidism).

Chronic fibrous thyroiditis

Course of chronic fibrous thyroiditis for a long time may not cause health problems with slow, gradual progression of structural changes in thyroid tissue. The earliest manifestation of fibrous thyroiditis is difficulty swallowing and a feeling of a “lump in the throat.” In the advanced stage of the disease, breathing, swallowing, speech disorders, hoarseness of the voice, and choking while eating develop.

Palpation reveals a significant uneven enlargement of the thyroid gland (tuberosity), its hardening, inactivity when swallowing, a dense “woody” consistency, and painlessness. Damage to the gland is, as a rule, diffuse in nature and is accompanied by a decrease in its functional activity with the development of hypothyroidism.

Compression of adjacent structures of the neck causes compression syndrome, manifested by headache, blurred vision, tinnitus, difficulty swallowing, pulsation of cervical vessels, and breathing problems.

Specific thyroiditis

Specific thyroiditis includes inflammatory and structural changes in the thyroid tissue of the thyroid gland during tuberculous, syphilitic, and mycotic lesions. Specific thyroiditis is chronic; in cases of secondary infection, they become acute.

Complications of thyroiditis

Purulent inflammation of the thyroid gland in acute thyroiditis, which occurs with the formation of an abscess, is fraught with autopsy purulent cavity into surrounding tissues: mediastinum (with the development of mediastinitis), trachea (with the development of aspiration pneumonia, lung abscess). The spread of a purulent process to the neck tissue can cause the development of neck phlegmon, vascular damage, hematogenous spread of infection to the meninges (meningitis) and brain tissue (encephalitis), and the development of sepsis.

The neglect of subacute thyroiditis causes damage to a significant number of thyrocytes and the development of irreversible thyroid failure.

Diagnosis of thyroiditis

In all forms of thyroiditis, changes in the general blood test are characterized by signs of inflammation: neutrophilic leukocytosis, a shift in the leukocyte count to the left, and an increase in ESR. The acute form of thyroiditis is not accompanied by changes in the level of thyroid hormones in the blood. In the subacute course, there is initially an increase in the concentration of hormones (stage of thyrotoxicosis), then a decrease occurs (euthyroidism, hypothyroidism). Ultrasound of the thyroid gland reveals focal or diffuse enlargement, abscesses, and nodes.

Scintigraphy of the thyroid gland determines the size and nature of the lesion. In the stage of hypothyroidism with subacute thyroiditis, there is a decrease in the absorption of iodine radioisotopes by the thyroid gland (less than 1%, with the norm being 15–20%); in the stage of euthyroidism with restoration of thyrocyte function, the accumulation of radioactive iodine is normalized, and in the recovery stage, due to the increased activity of regenerating follicles, it temporarily increases. Scintigraphy for fibrous thyroiditis can detect the size, unclear contours, and altered shape of the thyroid gland.

Treatment of thyroiditis

In mild forms of thyroiditis, you can limit yourself to observation by an endocrinologist, prescribing non-steroidal anti-inflammatory drugs to relieve pain, and symptomatic therapy. For severe diffuse inflammation, steroid hormones are used (prednisolone with a gradual reduction in dose).

In case of acute purulent thyroiditis, the patient is hospitalized in the surgery department. Active antibacterial therapy (penicillins, cephalosporins), vitamins B and C, antihistamines (mebhydrolin, chloropyramine, clemastine, cyproheptadine), massive intravenous detoxification therapy (saline solutions, rheopolyglucin) are prescribed. When an abscess forms in the thyroid gland, it is surgically opened and drained.

Treatment of subacute and chronic thyroiditis is carried out with thyroid hormones. With the development of compression syndrome with signs of compression of the neck structures, surgical intervention is resorted to. Specific thyroiditis is cured by treating the underlying disease.

Forecast and prevention of thyroiditis

Early treatment of acute thyroiditis ends with complete recovery of the patient after 1.5-2 months. Rarely, persistent hypothyroidism can develop after suffering purulent thyroiditis. Active therapy for subacute thyroiditis can achieve cure in 2-3 months. Advanced subacute forms can last up to 2 years and become chronic. Fibrous thyroiditis is characterized by many years of progression and development of hypothyroidism.

To prevent thyroiditis, the role of prevention of infectious and viral diseases is great: hardening, vitamin therapy, healthy nutrition and lifestyle. It is necessary to carry out timely sanitation of chronic foci of infection: treatment of caries, otitis, tonsillitis, sinusitis, pneumonia, etc. Compliance with medical recommendations and prescriptions, avoidance of an independent reduction in the dose of hormones or their withdrawal will avoid relapses of subacute thyroiditis.

ICD-10 code