Subacute thyroiditis (also known as De Quervain's thyroiditis and subacute granulomatous thyroiditis) is thought to occur following viral infection and typically presents with hyperthyroidism.


  • Incidence: 12.10 cases per 100,000 person-years
  • Peak incidence: 20-30 years
  • Sex ratio: more common in females 4:1
Condition Relative
Graves' disease4.13
Subacute (De Quervain's) thyroiditis1
Toxic thyroid nodule (adenoma)0.17
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Clinical features

There are typically 4 phases;
  • phase 1 (lasts 3-6 weeks): hyperthyroidism, painful goitre, raised ESR
  • phase 2 (1-3 weeks): euthyroid
  • phase 3 (weeks - months): hypothyroidism
  • phase 4: thyroid structure and function goes back to normal


  • thyroid scintigraphy: globally reduced uptake of iodine-131

Differential diagnosis

Venn diagram showing how different causes of thyroid dysfunction may manifest. Note how many causes of hypothyroidism may have an initial thyrotoxic phase.


  • usually self-limiting - most patients do not require treatment
  • thyroid pain may respond to aspirin or other NSAIDs
  • in more severe cases steroids are used, particularly if hypothyroidism develops