Endocrinology Book

Thyroid Disease

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Subacute Granulomatous Thyroiditis

Aka: Subacute Granulomatous Thyroiditis, Granulomatous Thyroiditis, Giant Cell Thyroiditis, Subacute Thyroiditis, de Quervain's Thyroiditis, de Quervain 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. Peak Incidence between ages 40 to 50 years
    3. More common in women by 4 fold
    4. Peak onset in late summer and early fall months
  3. Pathophysiology
    1. Associated with HLA-B35
    2. Thyroiditis associated with viral infection
      1. Coxsackievirus
      2. Echovirus
    3. Activated T-Lymphocytes injure Thyroid follicular cells (destructive Thyroiditis)
      1. Results in the initial T4 and T3 unbridled increase
      2. Ultimately T4 and T3 falls when stores are exhausted
  4. Symptoms
    1. Upper Respiratory Infection within prior 30 days (recalled by 25% of patients)
    2. Prodrome
      1. Myalgias
      2. Low-grade fever
      3. Pharyngitis
    3. Anterior Neck Pain in Thyroid region
      1. Hallmark symptom and often presenting complaint
      2. Tender, swollen Thyroid Gland and adjacent neck with radiation into jaw in some cases
    4. Associated symptoms
      1. Local compressive symptoms (e.g. Dysphagia)
      2. Hyperthyroidism symptoms (e.g. sweating, Tremor, weight loss)
  5. Signs
    1. Diffusely enlarged Thyroid
    2. No Proptosis (contrast with Grave's Disease)
    3. No pretibial Myxedema (contrast with Grave's Disease)
  6. Stages: Triphasic
    1. Phase 1: Hyperthyroidism (initial 4 to 8 weeks)
    2. Phase 2: Hypothyroidism (weeks to months)
      1. May persist indefinately (in up to 15% of cases)
      2. May require longterm Thyroid Replacement
    3. Phase 3: Euthyroid
      1. Thyroid function normalizes by 6-12 months (up to 18 months) in 85% of cases
  7. Differential Diagnosis
    1. See Painful Thyroiditis
    2. Suppurative Thyroiditis or Infectious Thyroiditis (rare)
      1. Associated with high fever, Leukocytosis and signs of toxicity
      2. FNA for culture and Gram Stain if suspected
    3. Radiation-Induced Thyroiditis (1% of I131 patients)
    4. Traumatic Thyroiditis (rare)
    5. Thyroid Hemorrhage
  8. 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 and other Thyroid studies
      1. Thyroid stimulating Antibody negative (contrast with Grave's Disease)
      2. Thyroid peroxidase Antibody or TPO Antibody positive (but at lower levels than with Hashimoto Thyroiditis)
      3. Thyroglobulin level increased
  9. Imaging
    1. Radioiodine Uptake (RAIU)
      1. Decreased uptake diffusely to <1-2% (unlike Grave's Disease in which the uptake is increased diffusely)
    2. Thyroid Ultrasound
      1. Nonuniform echotexture throughout the Thyroid Gland (contrast with cystic or solid mass in Hemorrhage or Infectious Thyroiditis)
  10. Management
    1. Thyroid pain (may persist for 5 weeks from onset)
      1. NSAIDs (inital medication)
        1. Ibuprofen 600 mg every 6 hours as needed
      2. Prednisone 40-60 mg orally daily for 5-7 days, then taper over 4 weeks
        1. Indicated if pain refractory to NSAIDs after 4-7 days on NSAIDs
        2. Pain relieved in most cases by 48 hours
        3. Not preventive of Thyroid dysfunction or longterm Hypothyroidism
    2. Hyperthyroidism symptoms
      1. See Hyperthyroidism for symptomatic treatment
      2. Beta Blocker (e.g. Propranolol) may be used for symptomatic management
    3. Hypothyroidism management
      1. Levothyroxine indicated in symptomatic Hypothyroidism and chronic Hypothyroidism
  11. Course
    1. Spontaneous resolution in most cases by 18 months after onset
    2. Persistent Hypothyroidism occurs in up to 15% of cases
      1. Requires longterm Thyroid replacment
    3. Recurrence in 2% of cases
  12. References
    1. Bindra (2006) Am Fam Physician 73(10):1769-76 [PubMed]
    2. Sweeney (2014) Am Fam Physician 90(6): 389-96 [PubMed]

Subacute thyroiditis (C0040149)

Definition (NCI) Self-limited inflammation of the thyroid gland characterized by the presence of multinucleated giant cells. Patients present with neck pain, often associated with fever and dysphagia. The clinical course includes an initial phase of hyperthyroidism, followed by a phase of hypothyroidism, and eventually a return to normal thyroid function.
Definition (NCI) Self-limited inflammation of the thyroid gland. The clinical course includes an initial phase of hyperthyroidism, followed by a phase of hypothyroidism, and eventually a return to normal thyroid function. This category includes the subacute lymphocytic thyroiditis and subacute granulomatous thyroiditis.
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, 428041004, 237533003, 237532008, 190296009, 237530000, 154666006, 237531001
English Subacute Thyroiditides, Thyroiditis, Subacute, Non-supp subacute thyroiditis, THYROIDITIS SUBACUTE, 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), deQuervain's thyroiditis, Thyroiditis subacute, Giant-cell thyroiditis, de Quervain thyroiditis, Thyroiditis, Subacute [Disease/Finding], de quervains thyroiditis, de quervain thyroiditis, granulomatous thyroiditis, thyroiditis de quervain, thyroiditis subacute, dequervain's thyroiditis, de quervain's thyroiditis, Non-suppurative subacute thyroiditis (disorder), Granulomatous thyroiditis (disorder), de Quervain's thyroiditis, De Quervain's thyroiditis (disorder), Giant-cell thyroiditis (disorder), 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, Tireoidite de Quervain, Tiroidite subaguda, Tireoidite de de Quervain, Tireoidite Subaguda
Spanish Tiroiditis granulomatosa, tiroiditis granulomatosa subaguda (trastorno), tiroiditis granulomatosa, tiroiditis de células gigantes, tiroiditis seudogranulomatosa, tiroiditis no supurativa subaguda, tiroiditis de De Quervain, tiroiditis granulomatosa de células gigantes, tiroiditis de de Quervain, tiroiditis granulomatosa subaguda, tiroiditis subaguda no supurante, tiroiditis subaguda no supurante (trastorno), Tiroiditis de Quervain, 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, ドケルバンコウジョウセンエン, ニクゲシュセイコウジョウセンエン, アキュウセイコウジョウセンエン, 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
Norwegian Tyreoiditt, subakutt, Kjempecelletyreoiditt, Subakutt tyreoiditt, De Quervains tyreoiditt, Granulomatøs tyreoiditt, Subakutt ikke-purulent tyreoiditt
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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