Endocrinology Book

Thyroid Disease

http://www.fpnotebook.com/

Subacute Granulomatous ThyroiditisAka: Giant Cell Thyroiditis, Subacute Thyroiditis, de Quervain's Thyroiditis

Advertisement

  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

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.
ConceptsDisease or Syndrome (T047)
ICD9245.1, 245.1
MSHD013968
EnglishDe Quervain Thyroiditis, De Quervain's thyroiditis, Giant Cell Thyroiditides, Giant Cell Thyroiditis, Giant-cell thyroiditis, Granulomatous Thyroiditides, Granulomatous Thyroiditis, Pseudogranulomatous thyroiditis, Subacute Granulomatous Thyroiditis, Subacute Nonsuppurative Thyroiditides, Subacute Nonsuppurative Thyroiditis, Subacute Painful Thyroiditides, Subacute Painful Thyroiditis, Subacute Thyroiditides, Subacute thyroiditis, THYROIDITIS SUBACUTE
Spanishtiroiditis de celulas gigantes, tiroiditis de de Quervain, tiroiditis granulomatosa, tiroiditis pseudogranulomatosa, tiroiditis subaguda
Parent ConceptsThyroiditis (C0040147), Subacute thyroiditis (C0040149), Duplicate concept (C1274013)
SourcesDXP, ICD9CM, MSH, MTH, MTHICD9, NCI, NDFRT, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



Navigation Tree