Subacute (De Quervain's) thyroiditis
Introduction
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.
Epidemiology
- Incidence: 12.10 cases per 100,000 person-years
- Peak incidence: 20-30 years
- Sex ratio: more common in females 4:1
| Condition | Relative incidence |
|---|---|
| Graves' disease | 4.13 |
| Subacute (De Quervain's) thyroiditis | 1 |
| 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
Investigations
Investigations
- thyroid scintigraphy: globally reduced uptake of iodine-131
Differential diagnosis
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Venn diagram showing how different causes of thyroid dysfunction may manifest. Note how many causes of hypothyroidism may have an initial thyrotoxic phase.
Management
Management
- 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