Subacute Thyroiditis (de Quervain)

Introduction

• Self-limiting hypothyroidism following a viral infection (URI) 
  • early on may be hyperthyroid (similar to Hashimoto’s)
• later, symptomatology is hypothyroid (though this is not permanent)

Presentation

• Physical exam
  • jaw pain
  • very tender thyroid gland 
    • post-partum lymphocytic subacute thyroiditis is painless
• no cervical adenopathy

Evaluation

• Labs
  • ↑ ESR
  • hyperthyroid phase: high T4, high T3, low TSH 
  • euthyroid phase: normal T4, T3, TSH
  • hypothyroid phase: normal/low T4 and T3, elevated TSH 
• Histology
  • granulomatous inflammation 
• ¹²³I uptake
• decreased

Treatment

• Manage symptoms (pain) with NSAIDS and aspirin
• Does not require treatment

Prognosis, Prevention, and Complications

• Rare to progress to permanent hypothyroidism