Makindo Medical Notes

Related Subjects: |Thyrotoxicosis and Hyperthyroidism |Thyroid Storm - Thyrotoxic crisis |Graves Disease (Thyrotoxicosis) |Amiodarone and Thyroid disease |Thyroid Surgery (Thyroidectomy) |Hypothyroidism |Hashimoto's thyroiditis |DeQuervain's thyroiditis |Subacute Thyroiditis |Thyroid nodule |Congenital Hypothyroidism |Thyroid Function Tests and antibodies |Post partum thyroiditis |Sick Euthyroid Syndrome |Thyroid Exam (OSCE) |Thyroid Gland anatomy and Physiology |Thyroid Cancer

It is advised not to treat either the hyperthyroid or the hypothyroid phase as De Quervain's thyroiditis often resolves spontaneously over time. Management should focus on symptomatic relief.

About

• De Quervain's Thyroiditis: Also known as subacute granulomatous thyroiditis or painful thyroiditis, it is a self-limiting inflammatory disorder of the thyroid.
• It is often viral in origin and leads to transient hyperthyroidism followed by hypothyroidism.
• Patients usually present with pain in the thyroid region and may show signs of systemic inflammation.

Aetiology

• Typically follows a viral infection such as:
  • Coxsackievirus
  • Epstein-Barr Virus (EBV)
  • Mumps, measles, and influenza
  • Adenovirus and echovirus
• Associated with genetic predisposition (e.g., HLA-B35).

Clinical Presentation

• Rarely presents as a thyroid storm or pyrexia of unknown origin (PUO).
• History of upper respiratory infection 3-6 weeks before symptoms appear.
• Initial symptoms may include:
  • Localized thyroid pain, which may radiate to the jaw or ears
  • Dysphagia (difficulty swallowing)
  • Hoarseness of voice
  • Fever, malaise, muscle aches
  • Signs of hyperthyroidism such as anxiety, sweating, and weight loss
• Typically progresses through three phases:
  • Acute Phase (3-6 weeks): Pain, hyperthyroidism, fever, and malaise.
  • Subacute Phase (2-4 weeks): Euthyroid (normal thyroid function).
  • Recovery Phase: Some patients may become transiently hypothyroid before normal thyroid function is restored.

Differential Diagnosis

• Hashimoto's Thyroiditis: Characterized by elevated anti-TPO antibodies (>500 U/mL).
• Graves' Disease: Typically presents with diffuse goiter, exophthalmos, and diffuse radioactive iodine uptake.
• Suppurative Thyroiditis: An acute bacterial infection of the thyroid.

Investigations

• Blood Tests: Elevated CRP/ESR and white cell count (WCC).
• Thyroid Function Tests (TFTs): Normal or high T4/T3 with suppressed TSH during hyperthyroid phase.
• Radioactive Iodine Uptake: Low or absent ¹²³I or ¹³¹I uptake during the hyperthyroid phase, helping differentiate from Graves' disease.

Management

• NSAIDs: First-line treatment for pain relief (e.g., ibuprofen, naproxen).
• Glucocorticoids: Steroids such as prednisolone (30-40 mg/day for 6 weeks) can be used in severe cases, though they may cause more side effects compared to NSAIDs alone.
• Beta-blockers: Symptomatic treatment of hyperthyroidism (e.g., propranolol).
• Thyroxine replacement: Required if the patient becomes hypothyroid during the recovery phase.
• Monitoring: Regular follow-up of thyroid function tests to track resolution of the thyroiditis and ensure return to normal function.

References

• Subacute, Granulomatous De Quervain's Thyroiditis