Thyroiditis, De Quervain, Subacute

• • 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

Epidemiology

• • 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

Symptoms and Signs

• • Thyroid swelling

  • Head and chest pain

  • Weakness, fever, malaise

  • Palpitations

  • Weight loss

  • Dysphagia

  • Odynophagia

Laboratory Findings

• • 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

Imaging Findings

• • Decreased uptake on radioiodine thyroid scan

Rule Out

• • Graves disease

  • Thyroid cancer

  • Acute suppurative thyroiditis

• • Physical exam

  • Thyroid function tests

  • Cervical ultrasound

  • Fine needle aspiration

• • Illness is usually self-limited

Medications

• • Aspirin, ibuprofen, or corticosteroids relieve symptoms

Treatment Monitoring

• • Monitor thyroid function

Prognosis

• • Patients are usually left euthyroid

  • 10% of patients have permanent hypothyroidism

References