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Subacute Thyroiditis

(de Quervain Thyroiditis; Giant Cell Thyroiditis; Granulomatous Thyroiditis)

By

Laura Boucai

, MD, Weill Cornell Medical College

Reviewed/Revised Feb 2024
View PATIENT EDUCATION

Subacute thyroiditis is an acute inflammatory disease of the thyroid probably caused by a virus. Symptoms include fever and thyroid tenderness. Initial hyperthyroidism is common, sometimes followed by a transient period of hypothyroidism. Diagnosis is clinical and with thyroid function tests. Treatment is with high doses of nonsteroidal anti-inflammatory drugs or with corticosteroids. The disease usually resolves spontaneously within months.

Symptoms and Signs of Subacute Thyroiditis

There is pain in the anterior neck and fever. Neck pain characteristically shifts from side to side and may settle in one area, frequently radiating to the jaw and ears. It is often confused with dental pain, pharyngitis, or otitis and is aggravated by swallowing or turning of the head. Symptoms of hyperthyroidism are common early in the disease because of hormone release from the disrupted follicles. There is more lassitude and prostration than in other thyroid disorders.

On physical examination, the thyroid is asymmetrically enlarged, firm, and tender.

Diagnosis of Subacute Thyroiditis

  • History and physical examination

  • Free thyroxine (T4) and thyroid-stimulating hormone (TSH) levels

  • Erythrocyte sedimentation rate (ESR)

  • Radioactive iodine uptake

Diagnosis is primarily clinical, based on finding an enlarged, tender thyroid in patients with the appropriate clinical history. Thyroid testing with TSH and at least a free T4 measurement is usually also done. Radioactive iodine uptake can be done to confirm the diagnosis.

Laboratory findings Laboratory Testing of Thyroid Function The thyroid gland, located in the anterior neck just below the cricoid cartilage, consists of 2 lobes connected by an isthmus. Follicular cells in the gland produce the 2 main thyroid hormones... read more early in the disease include an increase in free T4 and triiodothyronine (T3), a marked decrease in TSH, a low thyroid radioactive iodine uptake (often 0), and a high ESR. After several weeks, the thyroid is depleted of T4 and T3 stores, and transient hypothyroidism develops accompanied by a decrease in free T4 and T3, a rise in TSH, and recovery of thyroid radioactive iodine uptake. Weakly positive thyroid antibodies may be present.

Measurement of free T4, T3, and TSH at 2- to 4-week intervals identifies the stages of the disease.

When the diagnosis is uncertain, fine-needle aspiration biopsy is useful.

Treatment of Subacute Thyroiditis

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)

  • Sometimes corticosteroids, a beta-blocker, or both

Mild discomfort (eg, sore throat, mild neck tenderness, muscle aches, low-grade fever) is treated with high doses of aspirin or NSAIDs. In moderately or severely symptomatic cases (eg, high fever, tachycardia, shortness of breath), corticosteroids (eg, prednisone 15 to 30 mg orally once a day, gradually decreasing the dose over 3 to 4 weeks) eradicate all symptoms within 48 hours.

Bothersome symptoms of hyperthyroidism may be treated with a short course of a beta-blocker. If hypothyroidism is pronounced or persists, thyroid hormone replacement therapy may be required, rarely permanently.

Prognosis for Subacute Thyroiditis

Subacute thyroiditis is self-limited, generally subsiding in a few months; occasionally, it recurs and may result in permanent hypothyroidism Hypothyroidism Hypothyroidism is thyroid hormone deficiency. Symptoms include cold intolerance, fatigue, and weight gain. Signs may include a typical facial appearance, hoarse slow speech, and dry skin. Diagnosis... read more Hypothyroidism when follicular destruction is extensive.

Key Points

  • Manifestations of subacute thyroiditis are usually fever, neck pain, and an enlarged, tender thyroid.

  • Patients are initially hyperthyroid, with low levels of thyroid-stimulating hormone (TSH) and elevated free thyroxine (T4); they sometimes then become transiently hypothyroid, with high TSH and low free T4.

  • Treatment is with nonsteroidal anti-inflammatory drugs plus sometimes corticosteroids and/or a beta-blocker.

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NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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