无痛性淋巴细胞性甲状腺炎

自身免疫介导的甲状腺炎症伴随甲状腺激素释放（破坏性甲状腺炎），导致暂时性甲亢，在甲状腺功能恢复正常之前常伴随甲状腺功能减退期。

散发、发生于产后或在免疫调节治疗或锂治疗期间发生。

有些患者早期进展为永久性甲状腺功能减退，有些患者则几年或几十年后才进展。

可通过疾病甲状腺功能亢进期 4 小时、6 小时或 24 小时的放射性碘摄取＜1% 确诊。

如需要治疗，可在疾病的甲亢期使用β-受体阻滞剂，在甲状腺功能减退期使用左旋甲状腺素治疗。

此病的特征性地表现为甲状腺自身免疫介导的甲状腺淋巴细胞性炎症，引发破坏性甲状腺炎，伴甲状腺激素释放和一过性甲状腺毒症（甲状腺功能亢进）。[1]Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med. 2003 Jun 26;348(26):2646-55. https://www.doi.org/10.1056/NEJMra021194 http://www.ncbi.nlm.nih.gov/pubmed/12826640?tool=bestpractice.com [2]Woolf PD. Transient painless thyroiditis with hyperthyroidism: a variant of lymphocytic thyroiditis? Endocr Rev. 1980 Fall;1(4):411-20. http://www.ncbi.nlm.nih.gov/pubmed/7018893?tool=bestpractice.com [3]Samuels MH. Subacute, silent and postpartum thyroiditis. Med Clin North Am. 2012 Mar;96(2):223-33. http://www.ncbi.nlm.nih.gov/pubmed/22443972?tool=bestpractice.com 通常，紧接着的是甲状腺功能减退阶段和全面恢复阶段。

已接受的系统命名法存有争议，因为很多人把无痛性甲状腺炎视为慢性淋巴细胞性（桥本氏）甲状腺炎的一种变异表现，理由是桥本氏甲状腺炎可导致永久性的甲状腺功能减退症，且永久性的甲状腺功能减退症可在无痛性甲状腺炎的甲状腺功能减退期后很快发生，或在长期随访中发生。[2]Woolf PD. Transient painless thyroiditis with hyperthyroidism: a variant of lymphocytic thyroiditis? Endocr Rev. 1980 Fall;1(4):411-20. http://www.ncbi.nlm.nih.gov/pubmed/7018893?tool=bestpractice.com [3]Samuels MH. Subacute, silent and postpartum thyroiditis. Med Clin North Am. 2012 Mar;96(2):223-33. http://www.ncbi.nlm.nih.gov/pubmed/22443972?tool=bestpractice.com [4]Nikolai TF, Brousseau J, Kettrick MA, et al. Lymphocytic thyroiditis with spontaneously resolving hyperthyroidism (silent thyroiditis). Arch Intern Med. 1980 Apr;140(4):478-82. http://www.ncbi.nlm.nih.gov/pubmed/6892676?tool=bestpractice.com 这种疾病在产后尤为常见。 但是，产后甲状腺炎这一术语还包括因桥本氏甲状腺炎加重而出现仅为一过性甲状腺功能减退症的患者。[5]Stagnaro-Green A. Clinical review 152: postpartum thyroiditis. J Clin Endocrinol Metab. 2002 Sep;87(9):4042-7. http://press.endocrine.org/doi/full/10.1210/jc.2002-020524 http://www.ncbi.nlm.nih.gov/pubmed/12213841?tool=bestpractice.com 自身免疫性甲状腺病包括无痛性桥本氏甲状腺炎和 Graves 病，可能在免疫调节治疗和锂治疗过程中出现。[6]Muller I, Moran C, Lecumberri B, et al. 2019 European Thyroid Association guidelines on the management of thyroid dysfunction following immune reconstitution therapy. Eur Thyroid J. 2019 Jul;8(4):173-185. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738237 http://www.ncbi.nlm.nih.gov/pubmed/31602359?tool=bestpractice.com [7]Carella C, Mazziotti G, Amato G, et al. Clinical review 169: interferon-a-related thyroid disease: pathophysiological, epidemiological, and clinical aspects. J Clin Endocrinol Metab. 2004 Aug;89(8):3656-61. http://www.ncbi.nlm.nih.gov/pubmed/15292282?tool=bestpractice.com [8]Miller KK, Daniels GH. Association between lithium use and thyrotoxicosis caused by silent thyroiditis. Clin Endocrinol (Oxf). 2001 Oct;55(4):501-8. http://www.ncbi.nlm.nih.gov/pubmed/11678833?tool=bestpractice.com [9]Ahmadieh H, Salti I. Tyrosine kinase inhibitors induced thyroid dysfunction: a review of its incidence, pathophysiology, clinical relevance, and treatment. Biomed Res Int. 2013;2013:725410. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3824811 http://www.ncbi.nlm.nih.gov/pubmed/24282820?tool=bestpractice.com [10]Torino F, Barnabei A, Paragliola R, et al. Thyroid dysfunction as an unintended side effect of anticancer drugs. Thyroid. 2013 Nov;23(11):1345-66. http://www.ncbi.nlm.nih.gov/pubmed/23750887?tool=bestpractice.com 最后，破坏性甲状腺炎可能在其他情况下发生，其病理生理、评估和治疗都不同于无痛性甲状腺炎。 这些包括急性（化脓性），[11]Paes JE, Burman KD, Cohen J, et al. Acute bacterial suppurative thyroiditis: a clinical review and expert opinion. Thyroid. 2010 Mar;20(3):247-55. http://www.ncbi.nlm.nih.gov/pubmed/20144025?tool=bestpractice.com 亚急性（肉芽肿、de Quervain），[12]Fatourechi V, Aniszewski JP, Fatourechi GZ, et al. Clinical features and outcome of subacute thyroiditis in an incident cohort: Olmstead County, Minnesota, study. J Clin Endocrinol Metab. 2003 May;88(5):2100-5. http://press.endocrine.org/doi/full/10.1210/jc.2002-021799 http://www.ncbi.nlm.nih.gov/pubmed/12727961?tool=bestpractice.com 挤压性、[13]Stang MT, Yim JH, Challinor SM, et al. Hyperthyroidism after parathyroid exploration. Surgery. 2005 Dec;138(6):1058-64. http://www.ncbi.nlm.nih.gov/pubmed/16360391?tool=bestpractice.com 放射性[14]Aizawa T, Watanabe T, Suzuki N, et al. Radiation-induced painless thyrotoxic thyroiditis followed by hypothyroidism: a case report and literature review. Thyroid. 1998 Mar;8(3):273-5. http://www.ncbi.nlm.nih.gov/pubmed/9545116?tool=bestpractice.com 和胺碘酮所致甲状腺炎。[15]Basaria S, Cooper DS. Amiodarone and the thyroid. Am J Med. 2005 Jul;118(7):706-14. http://www.ncbi.nlm.nih.gov/pubmed/15989900?tool=bestpractice.com