Granulomatous thyroiditis: de Quervain’s thyroiditis
THE CONTEXT
Granulomatous thyroiditis, also called subacute or de Quervain’s thyroiditis, may follow a viral infection and usually resolves spontaneously.
Presentation and investigations
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The typical subacute presentation includes neck pain, fever, malaise and firm, irregular enlargement of one or both thyroid lobes.
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Inflammatory markers are raised, thyroid antibodies are absent, serum T4 is high normal or slightly raised, and iodine-123 uptake is low.
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Onset is acute in 10% of cases, with a very painful, tender goitre and possible symptoms of hyperthyroidism.
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One-third of cases are asymptomatic apart from the goitre.
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If diagnosis is uncertain, confirmation may involve FNAC, radioactive iodine uptake and a rapid symptomatic response to prednisone.
Natural course
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The condition is self-limiting, and the goitre subsides over a few months.
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A period of hypothyroidism lasting months may occur before eventual recovery.
Treatment
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Prednisone is specified for acute disease with severe pain. The initial daily treatment lasts 7 days, followed by gradual dose reduction over the next month.
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Thyroxine may be required when thyroid failure is prominent, until thyroid function recovers.