Updated: 12/21/2019

Subacute Thyroiditis

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
2 2
0
0
0%
0%
Evidence
2 2
0
0
Snapshot
  • A 40-year-old man presents to his primary care physician for palpitations. He had previously presented to the emergency room for similar reasons, when his EKG was found to be tachycardic but otherwise regular rhythm. He was sent home after intravenous hydration at that time. He reports that ever since an upper respiratory infection a few months ago, he has lost weight, felt fatigued, and experienced intermittent palpitations. He has no significant medical history.  He also reports having increasing jaw and anterior neck pain. On physical exam, his thyroid is very tender to palpation. No goiter was palpated. His T3 and T4 levels come back elevated, and his physician prescribes him 2 medications for this disease with reassurance that symptoms usually resolve over time.
Introduction
  • Clinical definition
    • a granulomatous autoimmune disease of the thyroid that causes hyperthyroidism that may be followed by a hypothyroid phase
      • also known as de Quervain or granulomatous thyroiditis
  • Epidemiology
    • demographics
      • women > men
      • adults
    • risk factors
      • viral infections
      • human leukocyte antigen-B35
      • family history
  • Pathogenesis
    • mechanism
      • transient inflammation of the thyroid gland causes release of ↑ T3 and T4
      • results from injury of thyroid follicles
  • Associated conditions
    • medical conditions and comorbidities
  • Prognosis
    • patients will generally return to normal thyroid function within a year
Presentation
  • Symptoms 
    • anterior neck and jaw pain
      • de Quervain causes pain
    • flu-like prodrome
      • fever, malaise, and fatigue
    • 3 phases
      • hyperthyroid phase
        • nervousness, tachycardia, and palpitations
        • sweating
        • resting tremor
        • hyperactive reflexes
      • hypothyroid phase
        • increased relaxation of deep tendon reflexes
      • euthyroid phase
Studies
  • Diagnostic testing
    • studies
      • T3/T4
        • ↑ during hyperthyroid phase
        • ↓ during hypothyroid phase
      • thyroid stimulating hormone (TSH)
        • ↓ during hyperthyroid phase
        • ↑ during hypothyroid phase
      • ↓ radioactive iodine uptake
        • i.e., gold standard for diagnosis
      • inflammatory markers C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR)
    • biopsy 
      • rarely needed but will show granulomatous inflammation
Differential
  • Postpartum thyroidits
    • distinguishing factor
      • thyroiditis after childbirth
      • painless thyroid
  • Silent thyroiditis
    • distinguishing factor
      • painless thyroid
      • hyperthyroidism followed by transient hypothyroidism
  • Riedel thyroiditis
    • distinguishing factor
      • hard and painless thyroid
Treatment
  • Management approach
    • because this disease is self-limited, management of symptoms is the mainstay treatment
  • First-line
    • nonsteroidal anti-inflammatory drugs (NSAIDs)
      • indication
        • mild symptoms
    • beta-blockers
      • indication
        • given with anti-inflammatory agents
  • Second-line
    • corticosteroids
      • indication
        • symptoms of thyrotoxicosis
        • refractory to NSAIDs
Complications
  • Recurrence
  • Permanent hypothyroidism
 

Please rate topic.

Average 3.8 of 4 Ratings

Questions (2)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M2.EC.14.67) A 45-year-old woman presents to the emergency department with a 1-week history of a painful mass in her neck. The patient reports the mass has slowly been enlarging over this time span and has become more painful to the touch. She also reports night sweats, weight loss, and diarrhea. Review of systems is notable only for a minor cold a few weeks ago. Her temperature is 100°F (37.8°C), blood pressure is 122/80 mmHg, pulse is 160/min, respirations are 19/min, and oxygen saturation is 100% on room air. Physical exam is notable for a diffusely enlarged thyroid that is tender to the touch. An ECG is performed as seen in Figure A. Which of the following is the most likely diagnosis? Tested Concept

QID: 103008
FIGURES:
1

Graves disease

100%

(7/7)

2

Hashimoto thyroiditis

0%

(0/7)

3

Riedel thyroiditis

0%

(0/7)

4

Silent thyroiditis

0%

(0/7)

5

Subacute granulomatous thyroiditis

0%

(0/7)

M 6 E

Select Answer to see Preferred Response

Evidence (2)
Topic COMMENTS (2)
Private Note