A to Z of Medical Conditions

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De Quervain’s thyroiditis – signs, symptoms and complications!

De Quervain's thyroiditis

De Quervain’s thyroiditis

Thyroiditis is swelling (inflammation) of the thyroid gland. It causes either unusually high or low levels of thyroid hormones in the blood.

The thyroid is a butterfly-shaped gland in the neck. It produces hormones that control the body’s growth and metabolism.

These hormones affect processes such as heart rate and body temperature, and convert food into energy to keep the body going.

There are several different types of thyroiditis.

Hashimoto’s thyroiditis

Hashimoto’s thyroiditis is caused by the immune system attacking the thyroid gland, making it swell and become damaged.

As the thyroid is destroyed over time, it becomes unable to produce enough thyroid hormone. This leads to symptoms of an underactive thyroid gland (hypothyroidism), such as tiredness, weight gain and dry skin.

The swollen thyroid may also cause a goitre (lump) to form in your throat.

It may take months or even years for the condition to be detected because it progresses very slowly.

It’s not understood what causes the immune system to attack the thyroid gland. Hashimoto’s thyroiditis is usually seen in women aged 30 to 50 and it sometimes runs in families.

It cannot be cured, but symptoms can be treated with levothyroxine, thyroid hormone replacement medication usually taken for life.

Surgery is needed only rarely – for instance, if your goitre is particularly uncomfortable or cancer is suspected.

Read about treating an underactive thyroid gland and treating goitre.

De Quervain’s (subacute) thyroiditis

De Quervain’s (subacute) thyroiditis is a painful swelling of the thyroid gland thought to be triggered by a viral infection, such as mumps or the flu.

It’s most commonly seen in women aged 20 to 50.

It usually causes fever and pain in the neck, jaw or ear. The thyroid gland can also release too much thyroid hormone into the blood (thyrotoxicosis), leading to symptoms of an overactive thyroid gland (hyperthyroidism), such as anxiety, insomnia and heart palpitations.

These symptoms settle after a few days. Symptoms of an underactive thyroid gland often follow, lasting weeks or months, before the gland recovers completely.

However, if symptoms continue to be severe, the thyroid swelling is one-sided (unilateral), and you continue to have a fever and feel unwell, then you may have infectious thyroiditis.

Palpitations and shakes associated with thyrotoxicosis can be treated with beta-blockers.

To relieve any pain, take over-the-counter painkillers such as aspirin (only if aged 16 or over) or ibuprofen. If these medications do not work, steroids (anti-inflammatory medicine) may be prescribed.

Occasionally, the condition may recur or the low thyroid hormone levels may be permanent, meaning you’ll need long-term thyroid hormone replacement medication.

Postpartum thyroiditis

Postpartum thyroiditis only affects a small number of women who have recently given birth.

However, it is more common in women with type 1 diabetes, positive thyroid antibodies and a previous history of postpartum thyroiditis.

In postpartum thyroiditis, the immune system attacks the thyroid within around six months of giving birth, causing a temporary rise in thyroid hormone levels (thyrotoxicosis) and symptoms of an overactive thyroid gland.

Then, after a few weeks, the gland becomes depleted of thyroid hormone, leading to low thyroid hormone levels and symptoms of an underactive thyroid gland.

However, not every woman with postpartum thyroiditis will go through both these phases.

If low thyroid hormone levels are causing severe symptoms, thyroid hormone replacement medication may be needed until the condition gets better.

If high thyroid hormones are causing symptoms, beta-blockers may provide relief.

In most women, thyroid function returns to normal within 12 months of the birth, although low thyroid hormone levels can sometimes be permanent.

Silent (painless) thyroiditis

Silent thyroiditis is very similar to postpartum thyroiditis, but it can occur in men and women, and is not related to giving birth.

Like postpartum thyroiditis, there may be a phase of high thyroid hormone levels (thyrotoxicosis) causing symptoms of an overactive thyroid gland. This may be followed by symptoms of an underactive thyroid gland, before the symptoms go away in 12 to 18 months.

If low thyroid hormone levels are causing severe symptoms, thyroid hormone replacement treatment may be needed until the condition gets better. In a few cases, the low thyroid levels can be permanent.

Drug-induced thyroiditis

Some medications can damage the thyroid and cause either symptoms of an overactive thyroid gland or symptoms of an underactive thyroid gland. Some examples are interferons (used to treat cancer), amiodarone (for heart-rhythm problems) and lithium (taken for bipolar disorder).

Symptoms are usually short-lived and may get better after you stop taking the medication.

However, you shouldn’t stop taking any prescribed medication without discussing it with your doctor.

Drug-induced thyroiditis can cause pain around the thyroid. This can be relieved with over-the-counter painkillers such as aspirin (only if aged 16 or over) or ibuprofen, although steroids (anti-inflammatory medication) may sometimes be needed.

Radiation-induced thyroiditis

The thyroid gland can sometimes be damaged by radiotherapy treatment or radioactive iodine treatment given for an overactive thyroid gland.

This can either lead to symptoms of an overactive thyroid gland or symptoms of an underactive thyroid gland.

Low thyroid hormone levels are usually permanent, so you may need lifelong thyroid hormone replacement treatment.

Acute or infectious thyroiditis

Acute or infectious thyroiditis is usually triggered by a bacterial infection. It is rare and is associated with either a weakened immune system or, in children, a problem with the development of the thyroid.

Symptoms may include pain in the throat, feeling generally unwell, swelling of the thyroid gland and, sometimes, symptoms of an overactive thyroid gland or symptoms of an underactive thyroid gland.

Symptoms usually get better when the infection is treated with antibiotics. Thyroid pain can be managed with over-the-counter painkillers such as aspirin (only if aged 16 or over) or ibuprofen.

If symptoms are severe with signs of infection, and particularly if the thyroid swelling appears to be one-sided (unilateral), an ultrasound scan of the thyroid may be needed to check for other problems.

Children usually need an operation to remove the abnormal part of the thyroid.

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Jaundice – what are the causes of Jaundice?

Jaundice

Jaundice

Jaundice is caused by a build-up of a substance called bilirubin in the blood and tissues of the body.

Any condition that disrupts the movement of bilirubin from the blood to the liver and out of the body can cause jaundice.

Bilirubin

Bilirubin is a waste product created when red blood cells break down. It’s transported in the bloodstream to the liver, where it’s combined with a digestive fluid called bile.

This eventually passes out of the body in urine or stools. It’s bilirubin that gives urine its light yellow colour and stools their dark brown colour.

Types of jaundice

There are three types of jaundice, depending on what’s affecting the movement of bilirubin out of the body.

Pre-hepatic jaundice

Pre-hepatic jaundice occurs when a condition or infection speeds up the breakdown of red blood cells. This causes bilirubin levels in the blood to increase, triggering jaundice.

Causes of pre-hepatic jaundice include:

malaria – a blood-borne infection spread by mosquitoes

sickle cell anaemia – an inherited blood disorder where the red blood cells develop abnormally; it’s most common among black Caribbean, black African and black British people

thalassaemia – similar to sickle cell; it’s most common in people of Mediterranean, Middle Eastern and, in particular, South Asian descent

Crigler-Najjar syndrome – a genetic syndrome where an enzyme needed to help move bilirubin out of the blood and into the liver is missing

hereditary spherocytosis – a genetic condition that causes red blood cells to have a much shorter life span than normal

Intra-hepatic jaundice

Intra-hepatic jaundice happens when a problem in the liver – for example, damage due to infection or alcohol, disrupts the liver’s ability to process bilirubin.

Causes of intra-hepatic jaundice include:

the viral hepatitis group of infections – hepatitis A, hepatitis B and hepatitis C

alcoholic liver disease – where the liver is damaged as a result of drinking too much alcohol

leptospirosis – a bacterial infection that’s spread by animals, particularly rats

glandular fever – a viral infection caused by the Epstein-Barr virus

drug misuse – leading causes are ecstasy and overdoses of paracetamol

primary biliary cirrhosis – a rare condition that causes progressive liver damage

Gilbert’s syndrome – a common genetic syndrome where the liver has problems breaking down bilirubin at a normal rate

liver cancer – a rare and usually incurable cancer that develops inside the liver

exposure to substances known to be harmful to the liver – such as phenol (used in the manufacture of plastic) or carbon tetrachloride (widely used in the past in processes such as refrigeration, although now its use is strictly controlled)

autoimmune hepatitis – a rare condition where the immune system starts to attack the liver

primary sclerosing cholangitis – a rare type of liver disease that causes long-lasting (chronic) inflammation of the liver

Dubin-Johnson syndrome – a rare genetic syndrome where the liver is unable to move bilirubin out of the liver

Post-hepatic jaundice

Post-hepatic jaundice is triggered when the bile duct system is damaged, inflamed or obstructed, which results in the gallbladder being unable to move bile into the digestive system.

Causes of post-hepatic jaundice include:

gallstones – obstructing the bile duct system

pancreatic cancer

gallbladder cancer or bile duct cancer

pancreatitis – inflammation of the pancreas, which can either be acute pancreatitis (lasting for a few days) or chronic pancreatitis (lasting for many years)

Some causes of jaundice are common, such as hepatitis and gallstones, whereas other causes, such as Crigler-Najjar syndrome and Dubin-Johnson syndrome, are much rarer.

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Kawasaki disease – what are the signs and symptoms of Kawasaki disease?

Kawasaki disease

Kawasaki disease

 

Kawasaki disease is a rare condition that mainly affects children under the age of five. It’s also known as mucocutaneous lymph node syndrome.

The characteristic symptoms are a high temperature that lasts for more than five days, with:

a rash

swollen glands in the neck

dry, cracked lips

red fingers or toes

red eyes

After a few weeks the symptoms become less severe, but may last longer. At this stage, the affected child may have peeling skin on their fingers and toes.

The symptoms of Kawasaki disease usually develop in three phases over a six-week period.

The three phases are described below.

Phase 1: acute (weeks 1-2)

Your child’s symptoms will appear suddenly and may be severe.

High temperature

The first and most common symptom of Kawasaki disease is usually a high temperature (fever) of 38C (100.4F) or above.

The fever can come on quickly and doesn’t respond to antibiotics or medicines typically used to reduce a fever, such as ibuprofen or paracetamol. If your child has a fever, they may be very irritable.

Your child’s fever will usually last for at least five days. However, it can last for around 11 days without the proper treatment. In some rare cases, the fever can last for as long as three to four weeks.

The fever may come and go, and your child’s body temperature could possibly reach a high of 40C (104F).

Rash

Your child may have a blotchy, red rash on their skin. It usually starts in the genital area before spreading to the torso, arms, legs and face.

The spots are usually red and raised, but there will not be any blistering.

Read more about skin rashes in children.

Hands and feet

The skin on your child’s fingers or toes may become red or hard, and their hands and feet may swell up.

Your child may feel their hands and feet are tender and painful to touch or put weight on, so they may be reluctant to walk or crawl while these symptoms persist.

Conjunctival injection

Conjunctival injection is where the whites of the eyes become red and swollen. Both eyes are usually affected, but the condition isn’t painful.

Unlike conjunctivitis, where the thin layer of cells that cover the white part of the eye (conjunctiva) becomes inflamed, fluid doesn’t leak from the eyes in conjunctival injection.

Lips, mouth, throat and tongue

Your child’s lips may be red, dry or cracked. They may also swell up and peel or bleed.

The inside of your child’s mouth and throat may also be inflamed. Their tongue may be red, swollen and covered in small lumps, also known as “strawberry tongue”.

Swollen lymph glands

If you gently feel your child’s neck, you may be able to feel swollen lumps on one or both sides. The lumps could be swollen lymph glands.

Lymph glands are part of the immune system, the body’s defence against infection. They may swell to over 1.5cm wide, feel firm and be slightly painful.

Phase 2: sub-acute (weeks 2-4)

During the sub-acute phase, your child’s symptoms will become less severe but may last longer. The fever should subside, but your child may still be irritable and in considerable pain.

Symptoms during the second phase of Kawasaki disease may include:

peeling skin on the fingers and toes – also sometimes on the palms of the hands or the soles of the feet

abdominal pain

vomiting

diarrhoea

urine that contains pus

feeling drowsy and lacking energy (lethargic)

headache

joint pain and swollen joints

yellowing of the skin and the whites of the eyes (jaundice)

It’s during the second phase of Kawasaki disease that complications are more likely to develop, such as a coronary artery aneurysm, which is a bulge in one of the blood vessels that supply blood to the heart.

Read more about the complications of Kawasaki disease.

Phase 3: convalescent (weeks 4-6)

Your child will begin to recover during the third phase of Kawasaki disease, which is known as the convalescent phase.

Your child’s symptoms should begin to improve and all signs of the illness should eventually disappear. However, your child may still have a lack of energy and become easily tired during this time.

Occasionally, complications can develop during the third phase of Kawasaki disease, but they’re more likely to develop before this stage.

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Endocarditis – what symptoms do you need to look out for?

Endocarditis

Endocarditis

The symptoms of endocarditis can develop rapidly over the course of a few days (acute endocarditis) or slowly, over the course of a few weeks or possibly months (subacute endocarditis).

Subacute endocarditis is more common in people with congenital heart disease.

Symptoms of endocarditis

The most common symptoms of endocarditis include:

a high temperature (fever) of 38C (100.4F) or above

chills

night sweats

headaches

shortness of breath, especially during physical activity

cough

heart murmurs – where your heart makes a whooshing or swishing noise between beats

tiredness (fatigue)

muscle and joint pain

Other symptoms can include:

the appearance of a spotty red rash on the skin (this is known as petechiae)

narrow, reddish-brown lines of blood that run underneath the nails

painful raised lumps that develop on the fingers and toes

painful red spots that develop on the palms of your hand and soles of your feet

mental confusion

When to seek medical advice

You should contact your GP as soon as possible if you develop any of the above symptoms, particularly if you’re at a higher risk of developing endocarditis, such as having a history of heart disease.

Read more about the causes of endocarditis.

These symptoms are more likely to be caused by a less serious type of infection. However, your doctor will want to investigate.

When to seek emergency medical advice

A stroke is one of the most serious complications that can develop from endocarditis.

If you suspect a stroke, you should dial 999 immediately to request an ambulance.

The most effective way to identify the symptoms of a stroke is to remember the word FAST, which stands for:

Face – the face may have fallen on one side, the person may be unable to smile, or their mouth or eye may have drooped

Arms – the person may be unable to raise both arms and keep them there as a result of weakness or numbness

Speech – the person’s speech may be slurred

Acute
Acute means occurring suddenly or over a short period of time.
Bacteria
Bacteria are tiny, single-celled organisms that live in the body. Some can cause illness and disease and some others are good for you.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Blood vessels
Blood vessels are the tubes in which blood travels to and from parts of the body. The three main types of blood vessels are veins, arteries and capillaries.
Fatigue
Fatigue is extreme tiredness and lack of energy.
Fever
A high temperature, also known as a fever, is when someone’s body temperature goes above the normal 37°C (98.6°F).
Haemorrhage
To haemorrhage means to bleed or lose blood.
Nodules
A nodule is a small growth or lump of tissue.
Inflammation
Inflammation is the body’s response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
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Bornholm disease – what is it and what are the signs and symptoms?

Bornholm disease

Bornholm disease

Bornholm disease (also called pleurodynia) is a viral infection that causes pain in the chest or upper tummy and flu-like symptoms.

It usually clears up by itself after a few days, but can sometimes last longer (up to three weeks).

Bornholm disease mainly affects children and young adults.

This page covers:

 

Symptoms of Bornholm disease

The main symptom of Bornholm disease is a severe stabbing chest pain, which is often worse when you breathe deeply, cough or move.

The pain tends to come and go, with episodes lasting 15-30 minutes. In very severe cases, the pain can make it difficult to breathe and the affected area may be tender.

Other symptoms of Bornholm disease include:

tummy pain

high temperature (fever)

headache

sore throat

cough

aching muscles

These symptoms usually start suddenly and last for a few days. They can sometimes last longer (up to three weeks), or they can come and go for a few weeks before eventually clearing up.

When to get medical help

If you have chest pain, it’s important to get it checked out, particularly if it’s severe and comes on suddenly. Get more advice about chest pain and when to get medical help.

Bornholm disease can be serious for newborn babies, so if you’re in the late stages of pregnancy or have a newborn baby and you’ve come into contact with someone with the condition, ask your midwife or GP for advice.

Treating Bornholm disease

There’s no specific treatment for Bornholm disease. The infection usually clears up on its own within a week.

As the condition is caused by a virus, it can’t be treated with antibiotics. You can use over-the-counter painkillers, such as paracetamol and ibuprofen, to help with any pain.

Newborn babies at risk of getting Bornholm disease may be treated with immunoglobin to make the effects of the virus less severe and help prevent complications. This is only offered on the advice of a specialist.

How the infection is spread

Bornholm disease is very infectious and can be easily spread from one person to another, usually through contact with secretions from the nose or mouth, or the poo of an infected person.

You can get infected by eating or drinking contaminated food or drink, or if you touch contaminated objects such as nappies and then touch your mouth.

This is why it’s very important to wash your hands properly and avoid sharing utensils if you or someone close to you has Bornholm disease.

Less commonly, you can catch Bornholm disease by breathing in infected droplets from coughs or sneezes.

As Bornholm disease is so infectious, there are sometimes outbreaks in schools or nurseries.