Subacute Thyroiditis Clinical Presentation

  • Author: Mark R Allee, MD; Chief Editor: George T Griffing, MD   more...
 
Updated: Feb 7, 2007
 

History

  • Pain is the predominant symptom. While the pain may be limited to the region of the thyroid, it may also involve the upper neck, throat, jaw or ears. Some patients may first consult an otolaryngologist. The pain may be so severe that the patient cannot tolerate palpation of the neck. The pain is most commonly bilateral. Occasionally, the pain may be unilateral, beginning in one lobe and spreading to the opposite side (creeping thyroiditis). Coughing, swallowing, or even tightening a necktie aggravates pain.
  • Systemic symptoms, including fatigue, malaise, and myalgia, are common. Fever (up to 104ºF) may also be present.
  • Thyrotoxic symptoms may be absent, mild, or moderate but rarely are severe. Up to 50% of the patients present with hyperthyroidism. Patients may complain of nervousness, heat intolerance, palpitations, tremulousness, and increased sweating.
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Physical

  • The thyroid is mildly to moderately enlarged, usually 2-3 times its normal size. It is exquisitely tender to palpation.
  • Rarely, the patient may present with a solitary nodule and tenderness.
  • The gland is firm to hard in consistency. The swelling is diffuse and involves the entire gland but may involve one lobe.
  • The presentation of hyperthyroidism may manifest with fever, tachycardia, and hyperreflexia.
  • Orbitopathy and dermopathy, which are characteristic of Graves disease, are absent.
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Causes

While most cases of subacute thyroiditis are secondary to a viral illness, other causes of subacute thyroiditis (SAT) exist and include the following:

  • Subacute thyroiditis has been described in patients receiving interferon-alpha for chronic hepatitis.
  • Radioiodine therapy for Graves disease can result in transient thyroidal inflammation, causing thyroiditis.
  • Subacute thyroiditis also has been described following external radiation to the neck.
  • Subacute thyroiditis has presented as a paraneoplastic manifestation of renal cell carcinoma.
  • An association between subacute thyroiditis and febrile neutrophilic dermatoses (Sweet syndrome) has been reported.
  • Concurrence of giant cell arteritis has been reported in patients with classic de Quervain thyroiditis.
  • Subacute thyroiditis has been described after bone marrow transplantation for chronic granulocytic leukemia.
  • Amiodarone may produce a painful thyroiditis with thyrotoxicosis.[2] While the major cause of amiodarone-induced thyrotoxicosis is iodine overload in a gland with underlying abnormalities, a direct toxic effect is observed in some patients.
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Contributor Information and Disclosures
Author

Mark R Allee, MD  Associate Professor, Department of Medicine, University of Oklahoma Health Sciences Center

Mark R Allee, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Mary Zoe Baker, MD  Professor, Department of Medicine, Section of Endocrinology, Metabolism and Hypertension, University of Oklahoma; Medical Director, University of Oklahoma Physicians, Medicine Specialty Clinic, General Medicine Clinic and Medicine Residents' Clinic

Mary Zoe Baker, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American Chemical Society, and American College of Physicians-American Society of Internal Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Steven R Gambert, MD, MACP  Chairman, Department of Medicine, Physician-in-Chief, Sinai Hospital of Baltimore; Professor of Medicine, Program Director, Internal Medicine Program, Johns Hopkins University School of Medicine

Steven R Gambert, MD, MACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American Geriatrics Society, Association of Professors of Medicine, Endocrine Society, and Gerontological Society of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Kent Wehmeier, MD  Professor, Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, St Louis University School of Medicine

Kent Wehmeier, MD is a member of the following medical societies: American Society of Hypertension, Endocrine Society, and International Society for Clinical Densitometry

Disclosure: Nothing to disclose.

Mark Cooper, MBBS, PhD, FRACP  Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

References

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  3. Salvi A, Spandrio S, Tosoni M. Liver enzyme abnormalities in subacute thyroiditis. Recenti Prog Med. Nov 1990;81(11):686-8. [Medline].

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  7. Garcia Solano J, Gimenez Bascunana A, Sola Perez J. Fine-needle aspiration of subacute granulomatous thyroiditis (De Quervain's thyroiditis): a clinico-cytologic review of 36 cases. Diagn Cytopathol. Mar 1997;16(3):214-20. [Medline].

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  17. Lio S, Pontecorvi A, Caruso M. Transitory subclinical and permanent hypothyroidism in the course of subacute thyroiditis (de Quervain). Acta Endocrinol (Copenh). May 1984;106(1):67-70. [Medline].

  18. Mizukami Y, Michigishi T, Kawato M. Immunohistochemical and ultrastructural study of subacute thyroiditis, with special reference to multinucleated giant cells. Hum Pathol. Sep 1987;18(9):929-35. [Medline].

  19. Ross DS. Syndromes of thyrotoxicosis with low radioactive iodine uptake. Endocrinol Metab Clin North Am. Mar 1998;27(1):169-85. [Medline].

  20. Sakata S, Nagai K, Maekawa H. Serum ferritin concentration in subacute thyroiditis. Metabolism. Jul 1991;40(7):683-8. [Medline].

  21. Shabb NS, Tawil A, Gergeos F. Multinucleated giant cells in fine-needle aspiration of thyroid nodules: their diagnostic significance. Diagn Cytopathol. Nov 1999;21(5):307-12. [Medline].

  22. Watts NB, Sewell CW. Carcinomatous involvement of the thyroid presenting as subacute thyroiditis. Am J Med Sci. Aug 1988;296(2):126-8. [Medline].

 
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