Subacute thyroiditis

Subacute thyroiditis (also termed De Quervain thyroiditis, granulomatous thyroiditis, or giant cell thyroiditis) is a self-limited inflammation of the thyroid gland. No specific therapy is generally necessary.

It is characterized by a triphasic course of transient thyrotoxicosis, followed by hypothyroidism, and then return to euthyroidism.

The thyrotoxic phase is due to thyroid follicular damage and release of preformed thyroid hormones into the circulation. This phase is characterized by very low radioactive iodine uptake by the thyroid.

Moderate-to-severe neck pain and tenderness, which may be migratory and affect different areas of the thyroid gland at different times, is typical of the thyrotoxic phase. The thyroid is often enlarged, firm, and tender to palpation.

Ultrasound of the thyroid may show areas of hypoechogenicity with decreased or normal vascular flow by Doppler.

Subacute thyroiditis (also termed De Quervain thyroiditis, granulomatous thyroiditis, or giant cell thyroiditis) is a self-limited inflammation of the thyroid gland. It is associated with a triphasic clinical course, in which each phase may last for a few weeks to many months. The three phases are characterized by transient thyrotoxicosis, hypothyroidism, and then a return to normal thyroid function, with the normal thyroid function occurring in >90% of patients.[1]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. http://www.ncbi.nlm.nih.gov/pubmed/18421188?tool=bestpractice.com [2]Fatourechi V, Aniszewski JP, Fatourechi GZ, et al. Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted county, Minnesota, study. J Clin Endocrinol Metab. 2003 May;88(5):2100-5. http://www.ncbi.nlm.nih.gov/pubmed/12727961?tool=bestpractice.com ​​​ 

The initial thyrotoxic phase is associated with thyroid pain, high serum thyroid hormone levels, and a low radioiodine uptake, and a systemic illness similar to influenza, with fever, myalgia, and malaise.​​[3]Stasiak M, Lewiński A. New aspects in the pathogenesis and management of subacute thyroiditis. Rev Endocr Metab Disord. 2021 Dec;22(4):1027-39. https://www.doi.org/10.1007/s11154-021-09648-y http://www.ncbi.nlm.nih.gov/pubmed/33950404?tool=bestpractice.com [4]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. https://www.liebertpub.com/doi/10.1089/thy.2016.0229 http://www.ncbi.nlm.nih.gov/pubmed/27521067?tool=bestpractice.com

A minority of patients (5% to 15%) remain permanently hypothyroid and require thyroid hormone replacement.[4]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. https://www.liebertpub.com/doi/10.1089/thy.2016.0229 http://www.ncbi.nlm.nih.gov/pubmed/27521067?tool=bestpractice.com