De Quervain’s thyroiditis or subacute granulomatous thyroiditis

 

De Quervain’s thyroiditis or subacute granulomatous thyroiditis a painful giant cell thyroiditis caused by viral infection of the upper respiratory tract like influenza, coxackie virus, mumps, adenoviruses. this form of thyroiditis can also occur postpartum.

Subacute granulomatous thyroiditis have a couple of periods, a late period or hypothyroid and an initial period a hyperthyroid.

Hyperthyroidism with neck pain, fever and dysphagia are the main symptoms in the initial phase, the differential diagnosis of this stage is carried with grave’s disease, for diagnostic matters a radionuclide (radioisotope or isotope) is administered into the thyroid to check for the thyroid uptake, in graves disease we will have an increased isotope uptake while in subacute thyroiditis the uptake is decreased.

Clinical Picture

This disease knows two periods, hypothyroidism and hyperthyroidism, but both periods share the following general symptoms:

• Enlargement of the thyroid, or thyroid goiter

• Painful neck (pain usually radiates to the jaw or ears)

• Fatigue
• Difficulty swallowing
• Fever
• Hoarseness
• Weakness
• Pain when the thyroid is palpated

Characteristic Symptoms of hyperthyroidism:

1. Diarrhea
2. Heat intolerance
3. Fatigue
4. Nervousness
5. Palpitations
6. Sweating and Tremor
7. Weight loss
8. Thyrotoxicosis

Characteristic symptoms of hypothyroidism:

1. Cold intolerance
2. Constipation

Diagnosis

Lab test findings in the 1st period (hyperthyroidism)

1. Low TSH level
2. High free T4
3. Low radio active iodine uptake
4. High serum thyroglobulin level
5. High ESR ( erythrocyte sedimentation rate)

Lab test findings in the late period (hypothyroidism):

1. High TSH level
2. low serum free T4

There may be low levels of anti-thyroid antibodies.

Treatment

In most cases, De Quervain’s thyroiditis resolves spontaneously after a period of time, but in some patients a permanent form of thyroiditis is developed.

Beta blockers (b-blockers, such as Propranolol) and NSAIDs (Cataflam, naproxen, ibuprofen) are the drugs of choice used to control this disease, but if this treatment proves ineffective, corticosteroids to be considered (prednisone).

Anti inflamatory pain killers such as panadol, aspirin or ibuprofen are used to control pain, while prednisone a corticosteroid is used to control inflammation.

Verified by: Dr.Diab (January 7, 2017)

Citation: Dr.Diab. (January 7, 2017). De Quervain’s thyroiditis. Medcoi Journal of Medicine, 6(2). urn:medcoi:article2086.