Subacute Thyroiditis



Also known as: de Quervain’s thyroiditis, granulomatous thyroiditis, or viral thyroiditis



What?

Postviral inflammatory process caused by common antigens in viruses and thyroid follicular cells



Who?

The peak incidence occurs at 30-50 years, and women are affected three times more frequently than men



How?

 → Patchy inflammatory infiltrate with disruption of the thyroid follicles and multinucleated giant cells

 → The follicular changes progress to granulomas

 → Fibrosis accompanies follicular changes

 → The thyroid returns to normal, usually several months after onset



Causes?

Viruses Associated with Sexual and Other Close Intimate Contact:

• Cytomegalovirus (CMV)

• HSV types 1 and 2

• EBV

• HIV



Respiratory Viruses:

• Influenza virus

• SARS-CoV-2



Vaccine-Preventable Viruses:

• Measles

• Mumps

• Rubella



Viruses Associated with Exposure to Children:

• Echovirus

• Parvovirus B19

• Coxsackievirus

• Varicella-zoster virus (VZV)



Presentation?

• Malaise and symptoms of an upper respiratory tract infection may precede the thyroid-related features by several weeks

• Symptoms can mimic pharyngitis/sore throat

• Painful and enlarged thyroid

• Fever

• Malaise and symptoms of an upper respiratory tract infection may precede the thyroid-related features

• Pain is often referred to the jaw or ear



Labs?

(1) Thyrotoxic phase: ↑ T4 and T3 levels, ↓ TSH

(2) Hypothyroid phase: ↓ T4 and ↓ TSH levels

(3) Recovery phase



Treatment?

• Aspirin (e.g., 600 mg every 4-6 h)

• Nonsteroidal anti-inflammatory drugs (NSAIDs)

• Marked Symptoms: 15-40 mg of prednisone



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