Tiroidite silente
E’ una forma molto rara a decorso subacuto, senza segni generali e locali di tipo infiammatorio, che è caratterizzata da tireotossicosi transitoria con captazione ridotta o assente. Si distingue dalla tiroide di De Quervain per l’assenza di dolore e il mancato rialzo della VES.
L’eziopatogenesi
Probabilmente autoimmune.
Sintomi
I sintomi sono quelli della tireotossicosi da distruzione e regrediscono spontaneamente dopo qualche mese. Puo’ seguire
una fase transitoria o permanente di ipotiroidismo. La captazione del radioiodio è ridotta o assente. Si riconosce una forma sporadica e una forma post-partum. La forma sporadica colpisce il sesso femminile con un rapporto F: M = 2 :1 e interessa tutte le età mentre la forma post partum costituisce circa il 70% di tutte le tiroiditi silenti e si osserva nel 5-8% dei periodi post-partum.
Si sviluppa in genere entro il primo anno dal parto per poi ripetersi ogni successiva gravidanza, soprattutto nelle donne con
autoanticorpi positivi. All’ istologia si osserva un processo distruttivo e un’ infiltrazione linfocitaria paragonabile a quella della tiroide di Hashimoto. Sono inoltre presenti granulomi come nella De Quervain.
Terapia
La terapia si basa sull’uso β– bloccanti nella fase di tireotossicosi e di L-tiroxina nel caso di ipotiroidismo transitorio o permanente.
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