Subacute granulomatous thyroiditis

Last reviewed: 3 Nov 2022
Last updated: 28 Mar 2018



History and exam

Key diagnostic factors

  • neck pain
  • tender, firm, enlarged thyroid
  • fever
  • palpitations
More key diagnostic factors

Other diagnostic factors

  • recent viral infection
  • myalgia
  • malaise
  • tremor
  • heat intolerance
Other diagnostic factors

Risk factors

  • viral infection
  • HLA-Bw35 and B35
More risk factors

Diagnostic investigations

1st investigations to order

  • thyroid-stimulating hormone (TSH)
  • total T4, total T3, T3 resin uptake, free thyroxine index
  • T3:T4 ratio
  • radioactive iodine uptake
  • ESR
  • CRP
  • antithyroid antibodies (thyroid peroxidase antibodies)
More 1st investigations to order

Investigations to consider

  • fine needle aspiration biopsy
More investigations to consider

Emerging tests

  • ultrasonography of thyroid
  • salivary CRP

Treatment algorithm


hyperthyroid phase

hypothyroid phase



Stephanie L. Lee, MD, PhD

Associate Chief

Director of the Thyroid Health Center

Section of Endocrinology, Diabetes and Nutrition

Boston Medical Center

Associate Professor of Medicine

Boston University School of Medicine




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


Not disclosed.

Ronald Merrell, MD

Professor of Surgery

Virginia Commonwealth University




RM declares that he has no competing interests.

Jim Stockigt, MD, FRACP, FRCPA

Consultant Endocrinologist

Epworth and Alfred Hospitals

Professor of Medicine

Monash University




At the time of review, JS declared that he had no competing interests. Unfortunately, we have since been made aware that JS is deceased.

  • Subacute granulomatous thyroiditis images
  • Differentials

    • Graves disease
    • Infectious, suppurative, or acute thyroiditis
    • Toxic multinodular goiter
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  • Guidelines

    • 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum
    • 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis
    More Guidelines
  • Patient leaflets

    Underactive thyroid

    More Patient leaflets
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