Painless lymphocytic thyroiditis

Last reviewed: 8 Nov 2022
Last updated: 18 Feb 2020

Summary

Definition

History and exam

Key diagnostic factors

  • heat intolerance
  • nervousness
  • small nontender goiter
  • 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

  • postpartum period
  • female sex
  • thyroid peroxidase (TPO) antibodies
  • imunnomodulatory therapy
  • lithium 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
  • TPO (thyroid peroxidase) 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
More investigations to consider

Emerging tests

  • color-flow Doppler

Treatment algorithm

ACUTE

thyrotoxic phase: mild

thyrotoxic phase: moderate

thyrotoxic phase: severe

ONGOING

hypothyroid phase: mild

hypothyroid phase: moderate to severe

recurrent thyroiditis

Contributors

Authors

Petros Perros, MD

Consultant

Department of Endocrinology

Newcastle upon Tyne Hospitals NHS Foundation Trust

Newcastle upon Tyne

UK

Disclosures

PP has been an invited speaker on thyroid topics for the British Endocrine Societies, the American Association of Clinical Endocrinologists Gulf Chapter, Lebanese Society of Endocrinology Diabetes and Lipids, Emirates Thyroid Congress, Cyprus Endocrine Society, European Group On Graves Orbitopathy, European Thyroid Association and Azerbaijan State Advanced Training Institute for Doctors. He has received honoraria for speaking at meetings organised by the American Association of Clinical Endocrinologists Gulf Chapter, the Lebanese Society of Endocrinology Diabetes and Lipids and Azerbaijan State Advanced Training Institute for Doctors and has done consultancy work for IBSA Institut Biochemie SA.

Acknowledgements

Dr Petros Perros would like to gratefully acknowledge Dr Douglas S. Ross, the previous contributor to this monograph. 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 (chronic lymphocytic) thyroiditis
    • Graves disease
    • Toxic multinodular goiter
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  • Guidelines

    • ACR practice parameter for the performance of therapy with unsealed radiopharmaceutical sources
    • 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum
    More Guidelines
  • Patient leaflets

    Underactive thyroid

    More Patient leaflets
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