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  • • Subacute or giant-cell thyroiditis

    • Noninfectious disorder

    • Can be present without pain (silent thyroiditis)

    • Self-limited disorder

    • Often follows upper respiratory infection, and thus postulated to have a viral etiology

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Epidemiology

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  • • 1% of all cases of thyroid disease

    • One-eighth the incidence of Graves disease

    • Most common cause of an anterior neck mass and pain in the thyroid

    • Uncommon in children

    • Most common in the third to fifth decade

    • Male:female ratio of 5:1

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Symptoms and Signs

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  • • Thyroid swelling

    • Head and chest pain

    • Weakness, fever, malaise

    • Palpitations

    • Weight loss

    • Dysphagia

    • Odynophagia

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Laboratory Findings

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  • • Elevated ESR

    • Elevated serum gamma globulin

    • Increased or normal thyroid hormone function tests

    • Decreased thyroid-stimulating hormone (TSH) levels

    • Decreased radioactive iodine uptake

    • Increased thyroglobulin

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Imaging Findings

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  • • Decreased uptake on radioiodine thyroid scan

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Rule Out

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  • • Graves disease

    • Thyroid cancer

    • Acute suppurative thyroiditis

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  • • Physical exam

    • Thyroid function tests

    • Cervical ultrasound

    • Fine needle aspiration

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  • • Illness is usually self-limited

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Medications

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  • • Aspirin, ibuprofen, or corticosteroids relieve symptoms

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Treatment Monitoring

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  • • Monitor thyroid function

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Prognosis

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  • • Patients are usually left euthyroid

    • 10% of patients have permanent hypothyroidism

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References

Daniels GH. Atypical subacute thyroiditis: preliminary observations. Thyroid 2001. 11(7):691-5.  [PubMed: 11484899]

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