What is Thyroiditis? Inflamed Thyroid Gland, Types of Thyroiditis

Thyroiditis is the term for inflammation of the thyroid gland, the bilobular gland located just below the voice box (larynx). The thyroid gland has several functions in the body but is best known for regulating the metabolism through the action of the thyroid hormones, thyroxine (T4) and triiodothyronine (T3). Thyroiditis includes several diseases of the thyroid gland with varying presentation and etiology – from infections to autoimmune disorders and drugs.

Although inflammation is almost always associated with pain, there are forms of thyroiditis where pain is absent and other features of inflammation are minimal. Some of these disorders are characterized primarily by the effect of abnormal levels of thyroid hormones. Thyroiditis may be acute, subacute or chronic – most acute and subacute types of thyroiditis are due to infections, while chronic thyroiditis is usually due to autoimmune factors.

Thyroiditis may lead to either an excess or deficiency of thyroid hormones. Some types of thyroiditis can be treated thereby restoring normal thyroid functioning. However in those types of thyroiditis where treatment cannot restore normal thyroid activity,  synthetic thyroid hormones or antithyroid medication is used to counteract the effects of thyroid dysfunction.

Acute thyroiditis is due to infections and often referred to as infectious thyroiditis. It can be caused by any pathogen but most cases are due to bacterial infections. Acute infectious thyroiditis usually does not result in thyroid dysfunction although mild hypothyroidism may be present at times. However this will resolve once the infection settles or is treated appropriately.Subacute granulomatous thyroiditis, also known as de Quervain’s thyroiditis, may possibly be triggered by a viral infection. Subacute lymphocytic thyroiditis (painless thyroiditis)  is linked to autoimmune causes and is similar to post partum thyroiditis. All these types of thyroiditis are characterized by hyperthyroidism (thyrotoxicosis) followed by hypothyroidism and usually lasts for 12 to 18 months.Hashimoto’s thyroiditis is a chronic type of thyroiditis that is due to autoimmune factors. The pathogenesis is closely related to subacute lymphocytic (painless) thyroiditis and post partum thyroiditis. It is characterized by hypothyroidism with thyrotoxicosis rarely seen in the initial stages of the disease.Drug-induced thyroiditis and radiation thyroiditis arise as a result of  therapeutic measures like the use of lithium or chemotherapeutic agents, radioactive iodine or radiation therapy. With drug-induced thyroiditis, the thyroid dysfunction (either thyrotoxicosis or hypothyroidism) usually wears off after stopping the drug. In radiation thyroiditis, however, the hypothyroidism that may follow the initial hyperthyroidism is usually permanent.Reidel’s thyroiditis or fibrous thyroiditis is rare type of chronic thyroiditis that results in the growth of fibrous tissue in the thyroid gland. The cause of Reidel’s thyroiditis is unknown but is possibly due to autoimmune factors.

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What is Whipple surgery? Reasons for Whipple procedure

Whipple surgery is a major surgical procedure involving the gastrointestinal organs like the distal part of stomach (latter portion), part of pancreas and duodenum (first part of the small intestine). The medical term for Whipple surgery is pancreaticoduodenectomy. It is a standard procedure for certain cases of pancreatic cancer but due to the close proximity of the distal part of the stomach and duodenum, these structures may also be removed. Refer to pancreas location and the picture below for more information.
Whipple surgery was first performed successfully by a German surgeon named Dr Kausch. It was later perfected by the American surgeon Dr Allen Whipple in the first half of the 20th century, after whom the procedure is named.

Picture from Wikimedia Commons
The pancreas is an important organ of digestion (exocrine functions) and also controls blood glucose levels (endocrine functions). This is explained further under pancreas function. Food enters the stomach through the esophagus and is mechanically churned by the muscular stomach wall with the stomach secretions containing hydrochloric acid and other enzymes. The partially digested food known as chyme is then passed into the first part of the small intestine (duodenum) for further digestion and nutrient absorption. Here the pancreatic juices containing digestive enzymes, water and bicarbonate ions mixes with the intestinal chyme.

Picture from Wikimedia Commons
(1) head of pancreas, (2) uncinate process of pancreas,(3) pancreatic notch, (4) body of pancreas, (5) anterior surface of pancreas, (6) inferior surface of pancreas, (7) superior margin of pancreas, (8) anterior margin of pancreas, (9) inferior margin of pancreas, (10) omental tuber. (11) tail of pancreas, (12) duodenum
The head of the pancreas and the duodenum are supplied by the same blood vessel known as the gastroduodenal artery. The artery passes through the head of the pancreas and the removal of head of pancreas can compromise the blood supply to duodenum. Therefore the duodenum is also removed along with head of the pancreas in the Whipple procedure.
The Whipple procedure is a standard operation performed in operable cancers of the head, neck and the uncinate process of the pancreas. Close to 70% cancers of pancreas arise from these parts but only about 20% of pancreatic cancer patients are diagnosed at an operable stage. The Whipple procedure is also performed in cancers of the ampulla of Vater, distal common bile duct or duodenum which are near to the pancreas. It may also be performed in painful chronic pancreatitis.


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Just What Is Diabetes?

The pancreas islet cells that produce insulin and glucose hormones work together to help regulate the correct levels of blood glucose. When the pancreatic islets cells, alpha (A cells) and beta (B cells) cannot regulate glucose and insulin properly, diabetes forms in the pancreas and other major organ systems. The pancreas is positioned behind the stomach, in the concavity that is produced by the C-shape of the duodenum. The duodenum curves around the head of the pancreas and handles acid from the stomach.

Pancreatic acid is also dumped into the duodenum and eventually exits through the ducts of the duodenum. The duodenum is also responsible for bile and secretions exiting into the duodenum from the liver. Inadequate insulin levels in the pancreas cause a decrease in the body’s ability to regulate blood sugar acidity in glucose, thus a risk factor for diabetes is developed throughout the body.      

Alpha and beta cells are called antagonists, because they work off their levels of hormones against each other, for proper concentrations of insulin and glucose. Insulin decreased and depletes organs from maintaining proper concentrations of glucose levels in the body. The alpha cells are responsible for the production of glucagon, and the beta cells are responsible for the production of insulin. As glucagon accelerates the process of glycogenolysis in the liver, it is then converted to glucose.