Thyroiditis Clinical Presentation

  • Author: Robert P Hoffman, MD; Chief Editor: Stephen Kemp, MD, PhD   more...
 
Updated: Nov 16, 2011
 

History

  • Acute thyroiditis
    • A history of acute illness, including fever, chills, neck pain, sore throat, hoarseness, and dysphagia, is common.
    • Neck pain is frequently unilateral and radiates to the mandible, ears, or occiput. Neck flexion reduces the severity of the pain. The pain worsens with neck hyperextension.
  • Subacute thyroiditis
    • Neck tenderness and swelling may occur.
    • Occasionally, the initial symptoms are those of hyperthyroidism.
    • Systemic symptoms such as weakness, fatigue, malaise, and fever are usually low grade.
  • Chronic autoimmune thyroiditis is observed in the following 3 patterns:
    • Goiter that is usually diffuse and nontender: Systemic illness is not evident. The thyroid gland is frequently 2-3 times its normal size and may be larger. The patient, parent, or physician may discover the goiter.
    • Symptoms of hypothyroidism: In children, this frequently includes poor growth or short stature. Adolescent girls may have primary or secondary amenorrhea. Boys may have delayed puberty. Because the disease develops slowly, the patient or parent may not notice other signs of hypothyroidism, including constipation, lethargy, and cold intolerance. The child with diabetes may have decreasing insulin requirement.
    • Symptoms of hyperthyroidism: These may include poor attention span, hyperactivity, restlessness, heat intolerance, or loose stools.
  • Asymptomatic thyroiditis with or without thyroid function abnormalities may also be discovered upon routine screening of children at high risk; these include children with Down syndrome or Turner syndrome and children with other autoimmune endocrine disorders (eg, type 1 diabetes, Addison disease, vitiligo).
  • The prevalence of celiac disease is increased in those with autoimmune thyroid disease and comorbidities such as type 1 diabetes and Down syndrome.[5]
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Physical

  • Acute thyroiditis
    • The patient may have a fever of 38-40°C.
    • Acute illness may be evident.
    • Neck tenderness is present, and the swollen thyroid gland is tender. The swelling and tenderness may be unilateral. Erythemas develop over the gland, and regional lymphadenopathy may develop as the disease progresses. Abscess formation may occur.
  • Subacute thyroiditis
    • The patient may have signs of systemic illness, such as low-grade fever and weakness.
    • Signs of hyperthyroidism, including increased pulse rate, widened pulse pressure, fidgeting, tremor, nervousness, tongue fasciculations, brisk reflexes (possibly with clonus), weight loss, and warm moist skin, may be present.
    • The thyroid gland may be enlarged and tender, with tenderness exacerbated by neck extension.
  • Chronic autoimmune thyroiditis
    • Initially, an enlarged, lumpy, bumpy, and nontender thyroid is often present. The gland may not be enlarged, particularly in children who have profound hypothyroidism. Signs of hypothyroidism include slow growth rate, weight gain, slow pulse, cold dry skin, coarse hair and facial features, edema, and delayed relaxation of the deep tendon reflexes.
    • Signs of hyperthyroidism are occasionally present early in the disease.
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Causes

  • Acute suppurative thyroiditis is more common in poorer geographic areas where antibiotic use is less prevalent. It usually occurs in children with embryologic abnormalities such as a persistent thyroglossal duct or brachial cleft cysts.
  • Chronic autoimmune thyroiditis is more common in developed countries with increased iodine intake.
  • Children with Down syndrome or Turner syndrome and those who have type 1 diabetes or another autoimmune endocrine disease are at particular risk of chronic thyroiditis.
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Contributor Information and Disclosures
Author

Robert P Hoffman, MD  Associate Professor of Pediatrics, Department of Pediatrics, Ohio State University College of Medicine

Robert P Hoffman, MD is a member of the following medical societies: American Diabetes Association, American Pediatric Society, Christian Medical & Dental Society, Endocrine Society, and Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Arlan L Rosenbloom, MD  Adjunct Distinguished Service Professor Emeritus of Pediatrics, University of Florida College of Medicine; Fellow of the American Academy of Pediatrics; Fellow of the American College of Epidemiology

Arlan L Rosenbloom, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Epidemiology, American Pediatric Society, Endocrine Society, Florida Pediatric Society, Pediatric Endocrine Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Lynne Lipton Levitsky, MD  Chief, Pediatric Endocrine Unit, Massachusetts General Hospital; Associate Professor of Pediatrics, Harvard Medical School

Lynne Lipton Levitsky, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Diabetes Association, American Pediatric Society, Endocrine Society, Pediatric Endocrine Society, and Society for Pediatric Research

Disclosure: Pfizer Grant/research funds P.I.; Tercica Grant/research funds Other; Eli Lily Grant/research funds PI; NovoNordisk Grant/research funds PI

Merrily P M Poth, MD  Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences

Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD  Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas for Medical Sciences College of Medicine, Arkansas Children's Hospital

Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, and Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

References

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  5. Sattar N, Lazare F, Kacer M, Aguayo-Figueroa L, Desikan V, Garcia M, et al. Celiac disease in children, adolescents, and young adults with autoimmune thyroid disease. J Pediatr. Feb 2011;158(2):272-5.e1. [Medline].

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  17. McCanlies E, O'Leary LA, Foley TP, et al. Hashimoto's thyroiditis and insulin-dependent diabetes mellitus: differences among individuals with and without abnormal thyroid function. J Clin Endocrinol Metab. May 1998;83(5):1548-51. [Medline]. [Full Text].

  18. Nordyke RA, Gilbert FI Jr, Miyamoto LA, Fleury KA. The superiority of antimicrosomal over antithyroglobulin antibodies for detecting Hashimoto's thyroiditis. Arch Intern Med. Apr 12 1993;153(7):862-5. [Medline].

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Three multinuclear, giant cell granulomas observed in a fine-needle aspiration biopsy of the thyroid; from a patient with thyrotoxicosis from lymphocytic or subacute granulomatous thyroiditis.
 
 
 
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