Highlights & Basics
- Subacute thyroiditis (also known as De Quervain thyroiditis, granulomatous thyroiditis, or giant cell thyroiditis) is inflammation of the thyroid characterized by a triphasic course of transient thyrotoxicosis, followed by hypothyroidism, followed by return to euthyroidism. However, the clinical manifestations of all three phases may not be apparent in all individuals.
- The thyrotoxic phase is due to thyroid follicular damage and release of preformed thyroid hormone. This phase is characterized by very low thyroid uptake on nuclear scan and elevated serum ESR or CRP levels.
- Moderate-to-severe neck pain and tenderness, which may be migratory and affect different areas of the thyroid gland at different times, is typical of the thyrotoxic phase. The thyroid is often enlarged, firm, and tender to palpation.
- Ultrasound of the thyroid may show areas of hypoechogenicity with decreased or normal vascular flow by Doppler.
- The condition is self-limited, and no specific therapy is generally necessary. Nonsteroidal anti-inflammatory drugs and beta-blockers may be used for hyperthyroid symptoms during the thyrotoxic phase. Some patients with severe hyperthyroid symptoms may also require corticosteroids, opioid analgesics, or potassium iodide or iopanoic acid to reduce the conversion of T4 to the more biologically active form of thyroid hormone, T3. During the hypothyroid phase, thyroid hormone replacement may help alleviate hypothyroid symptoms if severe.
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Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016 Oct;26(10):1343-421.[Abstract][Full Text]
Alexander EK, Pearce EN, Brent GA, et al. 2017 guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid. 2017 Mar;27(3):315-89.[Abstract][Full Text]
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