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Painless lymphocytic thyroiditis

Last reviewed: 5 Sep 2023
Last updated: 05 Jan 2023



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
  • 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
  • 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
  • color-flow Doppler ultrasound
More investigations to consider

Treatment algorithm


thyrotoxic (hyperthyroid) phase: mild

thyrotoxic (hyperthyroid) phase: moderate

thyrotoxic (hyperthyroid) phase: severe


hypothyroid phase: mild

hypothyroid phase: moderate to severe

recurrent thyroiditis



Petros Perros, MD

Honorary Consultant

Department of Endocrinology

Newcastle upon Tyne Hospitals NHS Foundation Trust

Newcastle upon Tyne



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).


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




JL declares that he has no competing interests.

Ronald Merrell, MD

Professor of Surgery

Virginia Commonwealth University




RM declares that he has no competing interests.

  • Differentials

    • Hashimoto (chronic lymphocytic) thyroiditis
    • Graves disease
    • Toxic multinodular goiter
    More Differentials
  • 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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