Subacute Thyroiditis Also known as: de Quervain’s thyroiditis, granulomatous thyroiditis, or viral thyroiditis What? Postviral inflammatory process caused by common antigens in viruses and thyroid follicular cells Who? The peak incidence occurs at 30-50 years, and women are affected three times more frequently than men How? → Patchy inflammatory infiltrate with disruption of the thyroid follicles and multinucleated giant cells → The follicular changes progress to granulomas → Fibrosis accompanies follicular changes → The thyroid returns to normal, usually several months after onset Causes? Viruses Associated with Sexual and Other Close Intimate Contact: • Cytomegalovirus (CMV) • HSV types 1 and 2 • EBV • HIV Respiratory Viruses: • Influenza virus • SARS-CoV-2 Vaccine-Preventable Viruses: • Measles • Mumps • Rubella Viruses Associated with Exposure to Children: • Echovirus • Parvovirus B19 • Coxsackievirus • Varicella-zoster virus (VZV) Presentation? • Malaise and symptoms of an upper respiratory tract infection may precede the thyroid-related features by several weeks • Symptoms can mimic pharyngitis/sore throat • Painful and enlarged thyroid • Fever • Malaise and symptoms of an upper respiratory tract infection may precede the thyroid-related features • Pain is often referred to the jaw or ear Labs? (1) Thyrotoxic phase: ↑ T4 and T3 levels, ↓ TSH (2) Hypothyroid phase: ↓ T4 and ↓ TSH levels (3) Recovery phase Treatment? • Aspirin (e.g., 600 mg every 4-6 h) • Nonsteroidal anti-inflammatory drugs (NSAIDs) • Marked Symptoms: 15-40 mg of prednisone #Subacute #Thyroiditis #deQuervains #endocrinology #thyroid #diagnosis #management
