subacute granulomatous thyroiditis; De Quervain's thyroiditis; giant-cell thyroiditis
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Introduction
Subacute granulomatous thyroiditis, De Quervain's thyroiditis or giant-cell thyroiditis is a self-limited granulomatous inflammation of the thyroid gland.
Etiology
- uncertain
- circumstantial evidence suggests viral origin
Epidemiology
- 80% in women 2nd to 5th decades of life
- 65-70% association with HLA-B35
- most common form of painful thyroid
Pathology
- minimally to markedly enlarged
- enlargement asymmetric or focal
- may be slightly adherent to surrounding structures
- acute inflammatory disruption of follicles with replacement by neutrophils early
- later stages of disease
- multinucleated giant cells enclosing pools or fragments of colloid
- chronic inflammatory infiltrates
- fibrosis
Clinical manifestations
- viral prodrome
- 3 patterns of presentation
- acute systemic febrile reaction with increased ESR
- sudden painful thyroid enlargement with:
- minimally painful enlargement of thyroid with transient hyperthyroidism
- may be hypothyroid phase following initial thyrotoxicosis
- recovery in 6-8 weeks
Laboratory
- elevated serum T3 & serum T4 as a result of damage to thyroid follicles
- suppressed serum TSH
- low radioactive iodine uptake
- elevated serum thyroglobulin
- elevated erythrocyte sedimentation rate (ESR)
- generally > 50 mm/hr
- occasionally > 100 mm/hr
- normal value virtually excludes diagnosis
- complete blood count (CBC)
- mild normocytic anemia
- normal or slightly increased WBC
- serum IL-6 levels are increased
Differential diagnosis
- hemorrhage into adenoma or carcinoma (nodule)
- malignant neoplasm of thyroid
- infectious thyroiditis
- subacute lymphocytic thyroiditis
- Graves disease
- multinodular goiter
- thyrotoxicosis after exposure to iodine containing contrast media[5]
- goiter, thyroid nodules
Management
- pharmacologic agents
- non-steroidal anti-inflammatory drugs (NSAIDs)
- prednisone 20-40 mg QD
- severe cases not responding to other therapy
- taper after 1 week with discontinuation in 2-4 weeks
- restart if pain recurs
- propranolol 20-40 mg PO QID or atenolol for hyperthyroidism
- follow-up
- generally duration of symptoms is 2-5 months
- 20% have recurrence
- permanent hypothyroidism in 5%
- continued observation necessary because thyroid abnormalities may persist
More general terms
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 646-650
- ↑ Cotran et al Robbins Pathologic Basis of Disease, 5th ed. W.B. Saunders Co, Philadelphia, PA 1994 pg 1128-29
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 209
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 18. American College of Physicians, Philadelphia 1998, 2012, 2018.
- ↑ 5.0 5.1 NEJM Knowledge+ Endocrinology