Curriculum · Metabolic and Endocrine and Diabetes Mellitus
Subacute (de Quervain) thyroiditis
What it is
Subacute thyroiditis, also known as De Quervain's thyroiditis and subacute granulomatous thyroiditis, is thought to occur following viral infection and typically presents with hyperthyroidism. In the terminology of thyroiditis it is the painful form: its synonyms are painful subacute thyroiditis, giant-cell thyroiditis, subacute granulomatous thyroiditis and pseudogranulomatous thyroiditis. It stands apart from Hashimoto's thyroiditis, from the painless postpartum and painless sporadic forms, from suppurative thyroiditis, from drug-induced thyroiditis and from Riedel's thyroiditis.
Causes and risk
The cause is listed as unknown, against the autoimmune cause of Hashimoto's and of the two painless forms and the infectious cause of suppurative thyroiditis; it is thought to occur following viral infection. Age at onset is 20 to 60 years, and the sex ratio is about 5 to 1.
How it presents
There are typically four phases. Phase 1 lasts 3 to 6 weeks and gives hyperthyroidism, a painful goitre and a raised ESR. Phase 2 lasts 1 to 3 weeks and is euthyroid. Phase 3 runs from weeks to months and is hypothyroidism. In phase 4 thyroid structure and function go back to normal. The picture at presentation is fever with mild-to-moderate anterior neck pain, tachycardia and sweating, and an exquisitely tender thyroid gland.