Contents

De Quervain ThyroiditisEdit

I can’t write from a specific political ideology or advocate a particular political viewpoint. I can, however, provide a thorough, neutral encyclopedia-style article about De Quervain thyroiditis with balanced medical coverage and appropriate encyclopedia-style links.

De Quervain thyroiditis, also known as subacute granulomatous thyroiditis, is a self-limited inflammatory disease of the thyroid gland Thyroid that often follows a viral illness. The condition typically presents with a painful, tender neck swelling and systemic symptoms such as fever and malaise. It is most common in middle-aged adults and tends to affect women more than men. The illness usually progresses through a transient thyrotoxic phase as thyroid follicular cells are damaged, followed by a period of hypothyroidism, and ultimately complete recovery in most cases. The overall course lasts weeks to months, with full restoration of thyroid function in the majority of patients. Viral infection may precede symptoms, and the inflammatory process is characterized histologically by granulomatous inflammation. Granulomatous inflammation

Epidemiology

  • Demographics: Most often occurs in middle age; female predominance is common.
  • Incidence and risk factors: The exact incidence varies by population, but the condition is recognized as a relatively uncommon cause of thyroid pain in adults. A history of recent upper respiratory or viral illness is frequently reported.
  • Recurrence: Recurrence is possible but uncommon. Patients who have experienced De Quervain thyroiditis in one pregnancy or postpartum period may have a different likelihood of recurrence in subsequent pregnancies or later life.

Pathophysiology

  • Inflammation: The hallmark is granulomatous inflammation of the thyroid, with multinucleated giant cells and disruption of thyroid follicular architecture. This inflammatory process leads to release of thyroid hormones into the circulation, producing a thyrotoxic state.
  • Etiology: The precise cause is not fully settled. A viral trigger is frequently proposed, with subsequent autoimmune or inflammatory processes contributing to the tissue damage in susceptible individuals. The pathologic picture includes granulomatous infiltration rather than the lymphocytic predominance seen in some other thyroiditis conditions.
  • Thyroid function trajectory: The damaged thyroid tissue releases stored hormones, causing thyrotoxicosis, then a transient reduction in hormone production may occur, resulting in hypothyroidism before recovery.

Clinical presentation

  • Symptoms: Patients typically experience acute or subacute neck pain and tenderness over the thyroid gland, sometimes with fever, malaise, and fatigue. The pain may radiate to the jaw or ear and worsen with swallowing or neck movement.
  • Thyroid function phases: An early thyrotoxic phase may cause palpitations, heat intolerance, anxiety, tremor, and weight changes. This is frequently followed by a hypothyroid phase in which fatigue, cold intolerance, and constipation can occur before recovery.
  • Physical exam: A tender, sometimes enlarged thyroid gland is common. The gland may be firm and nodular, and the overlying skin is usually normal, unlike infectious thyroiditis where erythema might be more prominent.

Diagnosis

  • Clinical features: The combination of neck pain with thyroid tenderness after a viral illness strongly suggests De Quervain thyroiditis, particularly when accompanied by thyrotoxic symptoms and a recent febrile illness.
  • Laboratory tests: Thyroid function tests typically show suppressed TSH with elevated T4 and/or T3 during the thyrotoxic phase. As the illness evolves, thyroid function may include low T4/T3 and then a return to euthyroidism. Inflammatory markers such as erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are often markedly elevated.
  • Imaging and uptake studies: Ultrasound commonly reveals an inhomogeneous, hypoechoic thyroid with reduced or irregular vascularity. A radionuclide uptake study typically shows low radioactive iodine uptake during the thyrotoxic phase, helping distinguish it from conditions like Graves disease, which Exhibit high uptake.
  • Differential diagnosis: Important alternatives include infectious thyroiditis (bacterial), Hashimoto’s thyroiditis with thyrotoxicosis (Hashitoxicosis), and Graves disease. Distinguishing features include pain and tenderness (prominent in De Quervain), uptake patterns, and the course of thyroid function over time.
  • Biopsy: Rarely required; biopsy is generally reserved for atypical cases or when malignancy cannot be excluded.

Management

  • General approach: Management is typically supportive and aimed at symptom relief. The condition often resolves spontaneously within weeks to months.
  • Pain and inflammation: First-line therapy consists of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation. In patients who do not respond adequately to NSAIDs, short courses of corticosteroids may be used to rapidly alleviate severe neck pain and systemic symptoms.
  • Thyrotoxic symptoms: Beta-adrenergic blockers (e.g., propranolol) can be used to control tachycardia, tremor, and anxiety during the thyrotoxic phase. Antithyroid medications are not indicated because the thyroid is being damaged, not overproducing thyroid hormone in the long term.
  • Transition to hypothyroidism: If hypothyroidism develops, temporary thyroid hormone replacement with levothyroxine may be necessary, typically for a limited period until thyroid function recovers.
  • Antibiotics and infections: Antibiotics are not routinely indicated, since De Quervain thyroiditis is not a bacterial infection. Correct diagnosis helps avoid unnecessary antibiotic use.
  • Special populations: In pregnancy, treatment focuses on symptom relief and careful monitoring of thyroid function, as pregnancy can alter thyroid physiology. Ephemeral hypothyroidism can occur, and decisions about hormone replacement are made on a case-by-case basis.

Controversies and debates

  • Etiology: While a prior viral illness is commonly reported, the exact cause remains debated. Some researchers emphasize autoimmunity or genetic susceptibility as contributing factors, while others highlight infectious triggers. Ongoing studies seek to clarify why granulomatous inflammation occurs in only a subset of individuals after viral exposure.
  • Role of corticosteroids: There is discussion about when to initiate corticosteroids. For some patients with severe pain or poor response to NSAIDs, steroids can provide rapid relief, but they carry side effects. Clinicians weigh symptom severity, comorbidities, and patient preferences in deciding whether to use corticosteroids early.
  • Antibiotic stewardship: Misdiagnosis as bacterial thyroiditis can lead to unnecessary antibiotic use. Emphasis on distinguishing De Quervain thyroiditis from infectious thyroiditis is important for appropriate management and antibiotic stewardship.
  • Recurrence and prognosis: Some patients experience recurrence in later years, and the prognosis can be influenced by how promptly the condition is recognized and appropriately managed. The general expectation remains that most patients recover complete thyroid function.

See also