eMedicine Specialties > Endocrinology > Thyroid

Subacute Thyroiditis: Follow-up

Author: Stephanie L Lee, MD, PhD, Fellow, Association of Clinical Endocrinology; Director of Thyroid Nodule and Cancer Center, Associate Chief, Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center; Associate Professor, Department of Medicine, Boston University School of Medicine
Coauthor(s): Sonia Ananthakrishnan, MD, Attending Physician, Department of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine/Boston Medical Center
Contributor Information and Disclosures

Updated: Apr 27, 2009

Follow-up

Further Outpatient Care

  • All forms of subacute thyroiditis - Patients should be seen every 4 weeks for reassurance and for measurement of thyroid hormone levels. Occasionally, patients have relapses of the thyrotoxic phase and have persistent symptoms. Monitor for the subsequent hypothyroid phase and treat with L-thyroxine if patients are symptomatic from the hypothyroidism.
  • Subacute granulomatous thyroiditis - Patients usually recover completely from painful subacute thyroiditis. The episodes rarely reoccur. Generally, patients are not prone to other thyroid disease and do not need long-term follow-up.
  • Lymphocytic and subacute postpartum thyroiditis - These conditions are sometimes associated with chronic thyroiditis. Postpartum thyroiditis usually recurs after each pregnancy. Occasionally, subacute painless thyroiditis is recurrent. Patients should be observed routinely every 6-12 months for the development of goiter or hypothyroidism from chronic thyroiditis.

Deterrence/Prevention

  • No medical intervention is known to prevent any form of subacute thyroiditis.
  • Recurrent episodes in patients with recurrent subacute thyroiditis with severe symptoms can be prevented with thyroidectomy.

Complications

  • Subacute granulomatous thyroiditis - This condition generally resolves completely in more than 90-95% of patients. No special follow-up of the thyroid is needed.
  • Lymphocytic thyroiditis - Occasionally, patients have recurrent episodes of painless thyrotoxicosis.5 No treatment exists to prevent the recurrences except subtotal thyroidectomy. This condition generally resolves completely in more than 90-95% of patients. Patients with goiters or permanent thyroid dysfunction should be monitored with a thyroid examination and thyroid function tests every 6 months.
  • Subacute postpartum thyroiditis - Usually, repeat episodes occur after each pregnancy, and no known treatment exists to prevent these. Patients may have a residual goiter and thyroid hypofunction after postpartum thyroiditis, because this condition is associated with chronic autoimmune thyroiditis. Patients should be observed routinely for goiter enlargement and thyroid hypofunction every 6-12 months.

Prognosis

  • The prognosis is excellent in 90-95% of patients who experience subacute thyroiditis. Approximately 5-10% of patients have permanent thyroid dysfunction, usually hypothyroidism, after an episode of subacute thyroiditis. Permanent goiter and thyroid dysfunction occur most frequently after postpartum thyroiditis.

Patient Education

  • Patients with subacute postpartum thyroiditis should be counseled that repeat episodes are likely to occur following every pregnancy.
  • For excellent patient education resources, visit eMedicine's Endocrine System Center. Also, see eMedicine's patient education article Thyroid Problems.

Miscellaneous

Medicolegal Pitfalls

  • Determining that elevated thyroid hormones levels are from the causes listed in this article and not from excess synthesis of thyroid hormone is important. Generally, the conditions described here are temporary (eg, subacute thyroiditis) and therefore do not require definitive therapy, such as thyroid surgery, radioactive iodine treatment, or antithyroid therapy. Radioactive iodine treatment and antithyroid therapy are never appropriate for these forms of subacute thyroiditis.
 


More on Subacute Thyroiditis

Overview: Subacute Thyroiditis
Differential Diagnoses & Workup: Subacute Thyroiditis
Treatment & Medication: Subacute Thyroiditis
Follow-up: Subacute Thyroiditis
Multimedia: Subacute Thyroiditis
References
Further Reading
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References

  1. Nishihara E, Ohye H, Amino N, et al. Clinical characteristics of 852 patients with subacute thyroiditis before treatment. Intern Med. 2008;47(8):725-9. [Medline]. [Full Text].

  2. Desailloud R, Hober D. Viruses and thyroiditis: an update. Virol J. Jan 12 2009;6:5. [Medline]. [Full Text].

  3. Filippi U, Brizzolara R, Venuti D, et al. Prevalence of post-partum thyroiditis in Liguria (Italy): an observational study. J Endocrinol Invest. Dec 2008;31(12):1063-8. [Medline].

  4. Omori N, Omori K, Takano K. Association of the ultrasonographic findings of subacute thyroiditis with thyroid pain and laboratory findings. Endocr J. Jul 2008;55(3):583-8. [Medline]. [Full Text].

  5. Nishimaki M, Isozaki O, Yoshihara A, Okubo Y, Takano K. Clinical characteristics of frequently recurring painless thyroiditis: contributions of higher thyroid hormone levels, younger onset, male gender, presence of thyroid autoantibody and absence of goiter to repeated recurrence. Endocr J. Feb 18 2009;[Medline]. [Full Text].

  6. Bartalena L, Brogioni S, Grasso L, Bogazzi F, Burelli A, Martino E. Treatment of amiodarone-induced thyrotoxicosis, a difficult challenge: results of a prospective study. J Clin Endocrinol Metab. Aug 1996;81(8):2930-3. [Medline]. [Full Text].

  7. Bartalena L, Grasso L, Brogioni S, et al. Serum interleukin-6 in amiodarone-induced thyrotoxicosis. J Clin Endocrinol Metab. Feb 1994;78(2):423-7. [Medline]. [Full Text].

  8. Basaria S, Cooper DS. Amiodarone and the thyroid. Am J Med. Jul 2005;118(7):706-14. [Medline].

  9. Dang AH, Hershman JM. Lithium-associated thyroiditis. Endocr Pract. May-Jun 2002;8(3):232-6. [Medline].

  10. Emerson CE, Farwell AP. Sporadic silent thyroiditis, postpartum thyroiditis, and subacute thyroiditis. In: Braverman LE, Utiger RD, eds. Werner and Ingbar's The Thyroid. 8th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2000:579-89.

  11. Hamburger JI. The various presentations of thyroiditis. Diagnostic considerations. Ann Intern Med. Feb 1986;104(2):219-24. [Medline].

  12. Hay ID. Thyroiditis: a clinical update. Mayo Clin Proc. Dec 1985;60(12):836-43. [Medline].

  13. Lambert M, Unger J, De Nayer P, et al. Amiodarone-induced thyrotoxicosis suggestive of thyroid damage. J Endocrinol Invest. Jun 1990;13(6):527-30. [Medline].

  14. Miller KK, Daniels GH. Association between lithium use and thyrotoxicosis caused by silent thyroiditis. Clin Endocrinol (Oxf). Oct 2001;55(4):501-8. [Medline].

  15. Nikolai TF, Brosseau J, Kettrick MA, et al. Lymphocytic thyroiditis with spontaneously resolving hyperthyroidism (silent thyroiditis). Arch Intern Med. Apr 1980;140(4):478-82. [Medline].

  16. Roti E, Minelli R, Giuberti T, et al. Multiple changes in thyroid function in patients with chronic active HCV hepatitis treated with recombinant interferon-alpha. Am J Med. Nov 1996;101(5):482-7. [Medline].

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Keywords

subacute thyroiditis, thyroid, hypothyroidism, thyroid disease, hyperthyroidism, hypothyroid, thyroid symptoms, thyroiditis, hyperthyroid, thyroid hormone, symptoms of thyroid, symptoms of thyroid problems, thyroid disorder, thyroxine, thyroid disorders, thyroid tests, thyroid hormones, T3 thyroid, T4 thyroid, thyrotoxicosis, postpartum thyroiditis, triiodothyronine, lymphocytic thyroiditis, de Quervain's, silent thyroiditis, de Quervain thyroiditis, subacute painless thyroiditis, subacute lymphocytic thyroiditis, subacute postpartum thyroiditis, subacute granulomatous thyroiditis, subacute painful thyroiditis, de Quervain's thyroiditis

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Contributor Information and Disclosures

Author

Stephanie L Lee, MD, PhD, Fellow, Association of Clinical Endocrinology; Director of Thyroid Nodule and Cancer Center, Associate Chief, Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center; Associate Professor, Department of Medicine, Boston University School of Medicine
Stephanie L Lee, MD, PhD is a member of the following medical societies: American College of Endocrinology, American Thyroid Association, and Endocrine Society
Disclosure: Nothing to disclose.

Coauthor(s)

Sonia Ananthakrishnan, MD, Attending Physician, Department of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine/Boston Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Stanley Wallach, MD, Executive Director, American College of Nutrition; Clinical Professor, Department of Medicine, New York University School of Medicine
Stanley Wallach, MD is a member of the following medical societies: American Society for Bone and Mineral Research, American Society for Clinical Investigation, American Society for Clinical Nutrition, American Society for Nutritional Sciences, Association of American Physicians, and Endocrine Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS, Professor of Medicine (Endocrinology, Adj), Johns Hopkins School of Medicine; Affiliate Research Professor, Bioinformatics and Computational Biology Program, School of Computational Sciences, George Mason University; Principal, C/A Informatics, LLC
Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Endocrinology, American College of Nutrition, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Informatics Association, American Society for Bone and Mineral Research, American Society of Law Medicine and Ethics, Endocrine Society, and International Society for Clinical Densitometry
Disclosure: Nothing to disclose.

CME Editor

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.

 
 
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