Forms of the disease are Hashimotos thyroiditis, the most common cause of hypothyroidism in the US, postpartum thyroiditis, subacute thyroiditis, silent thyroiditis, drug-induced thyroiditis, radiation-induced thyroiditis, acute thyroiditis, and Riedels thyroiditis.Each different type of this disease has its own causes, clinical features, diagnoses, durations, resolutions, conditions, and risks. Treatment
Treatments for this disease depend on the type of thyroiditis that is diagnosed. For the most common type, which is known as Hashimotos thyroiditis, the treatment is to immediately start hormone replacement. This prevents or corrects the hypothyroidism, and it also generally keeps the gland from getting bigger. However, Hashimotos thyroiditis can initially present with excessive thyroid hormone being released from the thyroid gland (hyperthyroid). In this case the patient may only need bed rest and non-steroidal anti-inflammatory medications; however, some need steroids to reduce inflammation and to control palpitations. Also, doctors may prescribe beta blockers to lower the heart rate and reduce tremors, until the initial hyperthyroid period has resolved. Epidemiology
Most types of thyroiditis are three to five times more likely to be found in women than in men. The average age of onset is between thirty and fifty years of age. This disease tends to be geographical and seasonal, and is most common in summer and fall. History
Hashimotos thyroiditis was first described by Japanese physician Hashimoto Hakaru working in Germany in 1912. Hashimotos thyroiditis is also known as chronic lymphocytic thyroiditis, and patients with this disease often complain about difficulty swallowing. This condition may be so mild at first that the disease goes unnoticed for years.
Invasive techniques such as cricothyrotomy must also be available in the event of inability to intubate the trachea by conventional techniques. RSI is mainly used to intubate patients at high risk of aspiration, mostly due to a full stomach as commonly seen in a trauma setting. Bag ventilation causes distention of stomach which can induce vomiting, so this phase must be quick. The patient is given a sedative and paralytic agent, usually midazolam / suxamethonium / propofol and intubation is quickly attempted with minimal or no manual ventilation. The patient is assessed for predictable intubation difficulties. Laryngoscope blades and endotracheal tubes smaller than would be used in a non-emergency setting are selected. If the patient on initial assessment is found to have a difficult airway, RSI is contraindicated since a failed RSI attempt will leave no option but to ventilate the patient on bag and mask which can lead to vomiting. For these challenging cases, awake fiberoptic intubation is usually preferred. Controversy
Since the introduction of RSI, there has been controversy regarding virtually every aspect of this technique, including:
choice of intravenous hypnotic agents as well as their dosage and timing of administration
dosage and timing of administration of neuromuscular blocking agents
avoidance of manual ventilation before tracheal intubation
optimal position and whether the head-up, head-down, or horizontal supine position is the safest for induction of anesthesia in full-stomach patients
application of cricoid pressure, which is also referred to as the Sellick maneuver. References
External links
Rapid Sequence Intubation at eMedicine