Endocrinology Book

Thyroid Disease

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Subacute Granulomatous Thyroiditis

Aka: Subacute Granulomatous Thyroiditis, Giant Cell Thyroiditis, Subacute Thyroiditis, de Quervain's Thyroiditis
  1. Definition
    1. Painful Thyroiditis associated with Viral Infection
  2. Epidemiology
    1. Incidence: 5 per 100,000 persons
      1. Most common cause of Painful Thyroiditis
    2. Most common at age 40 to 50 years
    3. More common in women by 4 fold
    4. Peak onset in summer months
  3. Pathophysiology
    1. Thyroiditis associated with viral infection
      1. Coxsackievirus
      2. Echovirus
    2. Activated T-Lymphocytes injure Thyroid follicular cells
      1. Results in the initial T4 and T3 unbridled increase
      2. Ultimately T4 and T3 falls when stores are exhausted
  4. Symptoms
    1. Prodrome
      1. Myalgias
      2. Low-grade fever
      3. Pharyngitis
    2. Neck Pain
      1. Tender, swollen Thyroid Gland and adjacent neck
  5. Signs
    1. No Proptosis (contrast with Grave's Disease)
    2. No pretibial Myxedema (contrast with Grave's Disease)
  6. Stages of Thyroiditis: Triphasic
    1. Phase 1: Hyperthyroidism (initial)
    2. Phase 2: Hypothyroidism (weeks to months)
      1. May persist indefinately
      2. May require longterm Thyroid Replacement
    3. Phase 3: Euthyroid (normalizes by 6-12 months)
  7. Labs
    1. Thyroid Function Tests (variable depending on phase)
      1. Thyroid Stimulating Hormone (TSH)
      2. Free T4
    2. Acute phase reactants
      1. Erythrocyte Sedimentation Rate (ESR) >50 mm/hour
      2. C-Reactive Protein (CRP)
      3. Complete Blood Count
        1. Mild Leukocytosis
        2. Mild Anemia
    3. Thyroid antibodies
      1. Negative (contrast with Grave's Disease, Hashimoto's)
  8. Imaging
    1. Radioiodine Uptake decreased (unlike Grave's Disease)
  9. Management
    1. Thyroid pain (may persist for 5 weeks from onset)
      1. NSAIDs (inital medication)
      2. Prednisone 40-60 mg orally daily, taper over 6 weeks
        1. Indicated if pain refractory to NSAIDs after week 1
        2. Pain relieved in most cases by 48 hours
        3. Not preventive of Thyroid dysfunction
    2. Hyperthyroidism symptoms
      1. See Hyperthyroidism for symptomatic treatment
      2. Example of management: Beta Blocker
  10. Course
    1. Spontaneous resolution in most cases
    2. Persistent Hypothyroidism can occur
      1. Requires longterm Thyroid replacment
    3. Recurrence in 2% of cases
  11. References
    1. Bindra (2006) Am Fam Physician 73(10):1769-76

Subacute thyroiditis (C0040149)

Definition (MSH) Spontaneously remitting inflammatory condition of the THYROID GLAND, characterized by FEVER; MUSCLE WEAKNESS; SORE THROAT; severe thyroid PAIN; and an enlarged damaged gland containing GIANT CELLS. The disease frequently follows a viral infection.
Concepts Disease or Syndrome (T047)
MSH D013968
ICD9 245.1
ICD10 E06.1
SnomedCT 38727009, 237533003, 428041004, 237530000, 237531001, 237532008, 154666006, 190296009
English Subacute Thyroiditides, Thyroiditis, Subacute, SUBACUTE THYROIDITIS, THYROIDITIS, DE QUERVAIN, THYROIDITIS, GIANT CELL, THYROIDITIS, PSEUDOTUBERCULOUS, THYROIDITIS, SUBACUTE, de Quervain's thyroiditis, Giant-cell thyroiditis, Non-supp subacute thyroiditis, THYROIDITIS SUBACUTE, Non-suppurative subacute thyroiditis (disorder), Granulomatous thyroiditis, De Quervain's thyroiditis, Non-suppurative subacute thyroiditis, Subacute granulomatous thyroiditis (disorder), Subacute granulomatous thyroiditis, Giant cell thyroiditis, subacute thyroiditis, subacute thyroiditis (diagnosis), De Quervain's thyroiditis (disorder), Giant-cell thyroiditis (disorder), Granulomatous thyroiditis (disorder), deQuervain's thyroiditis, Thyroiditis subacute, de Quervain thyroiditis, Thyroiditis, Subacute [Disease/Finding], subacute thyroidities, de quervains thyroiditis, de quervain thyroiditis, granulomatous thyroiditis, thyroiditis de quervain, thyroiditis subacute, dequervain's thyroiditis, de quervain's thyroiditis, Pseudogranulomatous thyroiditis, Subacute thyroiditis (disorder), Subacute thyroiditis, de Quervain; thyroiditis, giant cell; thyroiditis, granulomatous; thyroiditis, pseudotuberculous; thyroiditis, subacute; thyroiditis, thyroiditis; de Quervain, thyroiditis; giant cell, thyroiditis; granulomatous, thyroiditis; pseudotuberculous, thyroiditis; subacute, Subacute Thyroiditis, De Quervain's Thyroiditis, Subacute Granulomatous Thyroiditis, Giant cell thyroiditis,, De Quervain Thyroiditis, Thyroiditis, De Quervain, Cell Thyroiditides, Giant, Cell Thyroiditis, Giant, Giant Cell Thyroiditides, Giant Cell Thyroiditis, Granulomatous Thyroiditides, Granulomatous Thyroiditis, Nonsuppurative Thyroiditides, Subacute, Nonsuppurative Thyroiditis, Subacute, Painful Thyroiditides, Subacute, Painful Thyroiditis, Subacute, Subacute Nonsuppurative Thyroiditides, Subacute Nonsuppurative Thyroiditis, Subacute Painful Thyroiditides, Subacute Painful Thyroiditis, Thyroiditides, Giant Cell, Thyroiditides, Subacute Nonsuppurative, Thyroiditides, Subacute Painful, Thyroiditides, Subacute, Thyroiditis, Giant Cell, Thyroiditis, Granulomatous, Thyroiditis, Subacute Nonsuppurative, Thyroiditis, Subacute Painful, Thyroiditides, Granulomatous
Dutch subacute thyreoïditis, De Quervain-thyreoïditis, granulomateuze thyreoïditis, de Quervain; thyroïditis, granulomateus; thyroïditis, pseudotuberculeus; thyroïditis, reuscel; thyroïditis, subacuut; thyroïditis, thyroïditis; de Quervain, thyroïditis; granulomateus, thyroïditis; pseudotuberculeus, thyroïditis; reuscel, thyroïditis; subacuut, Subacute thyroïditis, thyreoïditis subacuut, De Quervain thyreoiditis, Subacute thyreoiditis, Thyreoiditis, De Quervain, Thyreoiditis, subacute, Thyroïditis, De Quervain
French Thyroïdite de Quervain, Thyroïdite sous-aiguë, Thyroïdite granulomateuse à cellules géantes, Thyroïdite subaigüe de De Quervain, Thyroïdite subaiguë granulomateuse, Thyroïdite subaigüe granulomateuse, Thyroïdite subaigüe, Thyroïdite de De Quervain, Thyroïdite granulomateuse, Thyroïdite subaiguë
German deQuervain-Thyroiditis, granulomatoese Thyroiditis, subakute Thyroiditis, Thyreoiditis de Quervain, Subakute nichteitrige Thyreoiditis, Riesenzellthyreoiditis, De-Quervain-Thyreoiditis, Granulomatöse Thyreoiditis, Subakute Thyreoiditis, Thyreoiditis subakut, Thyreoiditis, subakute
Italian Tiroidite di de Quervain, Tiroidite subacuta non suppurativa, Tiroidite a cellule giganti, Tiroidite subacuta dolorosa, Tiroidite di De Quervain, Tiroidite granulomatosa, Tiroidite subacuta
Portuguese Tiroidite de De Quervain, Tiroidite granulomatosa, Tiroidite subaguda, Tireoidite de de Quervain, Tireoidite de Quervain, Tireoidite Subaguda
Spanish Tiroiditis granulomatosa, Tiroiditis de Quervain, De Quervain's thyroiditis, Giant-cell thyroiditis, Subacute thyroiditis, Granulomatous thyroiditis, tiroiditis granulomatosa subaguda (trastorno), tiroiditis granulomatosa, tiroiditis de células gigantes, tiroiditis subaguda no supurante, tiroiditis seudogranulomatosa, tiroiditis subaguda no supurante (trastorno), tiroiditis no supurativa subaguda, tiroiditis de De Quervain, tiroiditis granulomatosa de células gigantes, tiroiditis de de Quervain, tiroiditis granulomatosa subaguda, tiroiditis pseudogranulomatosa, tiroiditis subaguda (trastorno), tiroiditis subaguda, Tiroiditis subaguda, Tiroiditis de De Quervain, Tiroiditis Subaguda
Japanese ド・ケルバン甲状腺炎, ﾄﾞｹﾙﾊﾞﾝｺｳｼﾞｮｳｾﾝｴﾝ, ﾆｸｹﾞｼｭｾｲｺｳｼﾞｮｳｾﾝｴﾝ, ﾆｸｶﾞｼｭｾｲｺｳｼﾞｮｳｾﾝｴﾝ, ｱｷｭｳｾｲｺｳｼﾞｮｳｾﾝｴﾝ, 肉芽腫性甲状腺炎, 亜急性甲状腺炎, ドケルバン甲状腺炎, ド･ケルヴァン甲状腺炎, 甲状腺炎-亜急性, De Quervain甲状腺炎
Swedish Tyreoidit, subakut
Czech tyreoiditida subakutní, deQuervainova tyreoiditida, Subakutní tyreoiditida, Granulomatózní tyreoiditida, Subakutní zánět štítné žlázy
Finnish Subakuutti kilpirauhastulehdus
Russian DE KERVENA TIREOIDIT, TIREOIDIT PODOSTRYI, ДЕ КЕРВЕНА ТИРЕОИДИТ, ТИРЕОИДИТ ПОДОСТРЫЙ
Korean 아급성 갑상샘염
Croatian TIREOIDITIS, SUBAKUTNI
Polish Zapalenie tarczycy podostre
Hungarian DeQuervain-thyreoiditis, Subacut pajzsmirigy-gyulladás, Subacut thyreoiditis, Granulomás thyreoiditis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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