Painless lymphocytic thyroiditis

Last reviewed: 7 Jan 2023
Last updated: 05 Jan 2023

Summary

Definition

History and exam

Key diagnostic factors

  • heat intolerance
  • nervousness
  • small non-tender goitre
  • tremulousness
More key diagnostic factors

Other diagnostic factors

  • palpitations
  • weight loss
  • excessive fatigue
  • bloating
  • muscle cramps
  • weight gain
  • poor concentration
  • cold intolerance
  • tachycardia
Other diagnostic factors

Risk factors

  • postnatal period
  • female sex
  • thyroid peroxidase (TPO) antibodies
  • immunomodulatory therapy
  • lithium therapy
  • amiodarone therapy
  • type 1 diabetes and other autoimmune conditions
  • autoimmune family history
More risk factors

Diagnostic investigations

1st investigations to order

  • thyroid-stimulating hormone (TSH)
  • serum free T4 and T3
  • thyroid peroxidase (TPO) antibodies
  • TSH-receptor antibodies (TRAb)
  • 4-, 6-, or 24-hour radioiodine uptake
  • total T3/T4 ratio
More 1st investigations to order

Investigations to consider

  • technetium-99m pertechnetate scan
  • serum thyroglobulin
  • thyroid biopsy
  • colour-flow Doppler ultrasound
More investigations to consider

Treatment algorithm

ACUTE

thyrotoxic (hyperthyroid) phase: mild

thyrotoxic (hyperthyroid) phase: moderate

thyrotoxic (hyperthyroid) phase: severe

ONGOING

hypothyroid phase: mild

hypothyroid phase: moderate to severe

recurrent thyroiditis

Contributors

Authors

Petros Perros, MD

Honorary Consultant

Department of Endocrinology

Newcastle upon Tyne Hospitals NHS Foundation Trust

Newcastle upon Tyne

UK

Disclosures

PP has received consultancy fees, served as a member of an advisory board, and been reimbursed for attending conferences held by IBSA Institut Biochimique SA (the manufacturer of Tirosint).

Acknowledgements

Dr Petros Perros would like to gratefully acknowledge Dr Douglas S. Ross, the previous contributor to this topic. DSR declares that he has no competing interests.

Peer reviewers

John Lazarus, MA, MD, FRCP, FACE, FRCOG

Centre for Endocrine and Diabetes Sciences

Cardiff University School of Medicine

University Hospital of Wales

Heath Park

Cardiff

UK

Disclosures

JL declares that he has no competing interests.

Ronald Merrell, MD

Professor of Surgery

Virginia Commonwealth University

Richmond

VA

Disclosures

RM declares that he has no competing interests.

  • Differentials

    • Hashimoto's (chronic lymphocytic) thyroiditis
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  • Guidelines

    • Thyroid disease: assessment and management
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  • Patient leaflets

    Underactive thyroid

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