Subacute (de Quervain’s) Thyroiditis

Posted by e-Medical PPT Friday, May 25, 2012
Thyrotoxicosis - differential
Graves’disease
Toxic adenoma (solitary)
Toxic multinodular goiter
Subacute thyroiditis
Hashimoto’s thyroiditis (transient hyperthyroid phase)
Thyrotoxicosis factitia
Postpartum
Struma ovarii
Metastatic thyroid carcinoma
Hydatidaform mole
TSH-secreting pituitary tumor
Pituitary resistance to triiodothryonine and thyroxine

Thyroiditis – Classification
Hashimoto’s thyroiditis - Chronic lymphocytic thyroiditis, Chronic autoimmune thyroiditis, Lymphadenoid goiter
Painless postpartum thyroiditis - Postpartum thyroiditis, Subacute lymphocytic thyroiditis
Painless sporadic thyroiditis - Silent sporadic thyroiditis, subacute lymphocytic thyroiditis
Painful subacute thyroiditis - Subacute thyroiditis, de Quervain’s thyroiditis, Giant-cell thyroiditis, Subacute granulomatous thyroiditis, pseudogranulomatous thyroiditis
Suppurative thyroiditis - Infectious thyroiditis, Acute suppurative thyroiditis, pyrogenic thyroiditis, bacterial thyroiditis
Drug-induced thyroiditis (amiodarone, lithium, interferon alfa, interleukin-2)
Riedel’s thyroiditis

Subacute thyroiditis - features
5:1 female predominance
Age of onset 20-60y
Prodrome (myalgias, fever, pharyngitis)
Seasonal variation (?correlation with enterovirus?)
Fever/severe neck pain
50-60% develop thyrotoxicosis
2-9% with recurrent disease
Normal thyroid function returns in 95%
5% residual hypothyroidism
Usually low to absent titer of anti-TPO immunoglobulins

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