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
- HLA-Bw35 and B35
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)
Investigations to consider
- fine needle aspiration biopsy
Emerging tests
- ultrasonography of thyroid
- salivary CRP
Treatment algorithm
hyperthyroid phase
hypothyroid phase
Contributors
Authors
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
Boston
MA
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.
Jim Stockigt, MD, FRACP, FRCPA
Consultant Endocrinologist
Epworth and Alfred Hospitals
Professor of Medicine
Monash University
Melbourne
Australia
Disclosures
At the time of review, JS declared that he had no competing interests. Unfortunately, we have since been made aware that JS is deceased.
Differentials
- Graves disease
- Infectious, suppurative, or acute thyroiditis
- Toxic multinodular goiter
More DifferentialsGuidelines
- 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 GuidelinesPatient leaflets
Underactive thyroid
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