Summary
Definition
History and exam
Key diagnostic factors
- neck pain
- tender, firm, enlarged thyroid
- fever
- palpitations
Other diagnostic factors
- recent viral infection
- myalgia
- malaise
- tremor
- heat intolerance
Risk factors
- viral infection
- Certain HLA and B35 alleles
Diagnostic tests
1st tests to order
- serum thyroid-stimulating hormone (TSH)
- serum total T4, total T3, free T3, free T4 index, and free T4
- T3:T4 ratio
- radioactive iodine uptake
- Serum ESR
- Serum CRP
- Serum thyroid antibodies (thyroid peroxidase antibodies [TPO Ab])
Tests to consider
- fine needle aspiration biopsy
- complete blood count
Emerging tests
- ultrasonography of thyroid
Treatment algorithm
hyperthyroid (thyrotoxic) phase
hypothyroid phase
Contributors
Authors
Angela M. Leung, MD, MSc
Associate Professor of Medicine
UCLA David Geffen School of Medicine
VA Greater Los Angeles Healthcare System
Los Angeles
CA
Disclosures
AL has served on the board of directors of the American Thyroid Association. She is editor-in-chief of Clinical Thyroidology, a journal of the American Thyroid Association. AL is a speaker for Medical Education Resources and MCE Conferences. She has consulted for Vertice Pharma and received article process charges paid by IBSA Institut Biochimique for an invited review article. AL has lectured at a conference sponsored by Merck and presented educational content for the Endocrine Society and the American Association of Clinical Endocrinology. AL is an advisor to Medscape and has received research funding from the U.S. Dept of Veterans Affairs.
Acknowledgements
Dr Angela M. Leung would like to gratefully acknowledge Dr Stephanie L. Lee, the previous contributor to this topic.
Disclosures
SLL declares that she has no competing interests.
Peer reviewers
Georg Hennemann, MD
Professor of Medicine and Endocrinology
Medical Center Spijkenisse
The Hague
The Netherlands
Disclosures
Not disclosed.
Ronald Merrell, MD
Professor of Surgery
Virginia Commonwealth University
Richmond
VA
Disclosures
RM declares that he has no competing interests.
References
Key articles
Nishihara E, Ohye H, Amino N, et al. Clinical characteristics of 852 patients with subacute thyroiditis before treatment. Intern Med. 2008;47(8):725-9. Abstract
Stasiak M, Lewiński A. New aspects in the pathogenesis and management of subacute thyroiditis. Rev Endocr Metab Disord. 2021 Dec;22(4):1027-39.Full text Abstract
Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016 Oct;26(10):1343-421.Full text Abstract
Alexander EK, Pearce EN, Brent GA, et al. 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017 Mar;27(3):315-89.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Graves disease
- Infectious, suppurative, or acute thyroiditis
- Toxic multinodular goiter
More DifferentialsGuidelines
- Thyroid disease: assessment and management
- 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum
More GuidelinesPatient information
Underactive thyroid
More Patient informationLog in or subscribe to access all of BMJ Best Practice
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