De Quervain thyroiditis

De Quervain thyroiditis, also called subacute granulomatous thyroiditis or giant cell thyroiditis, is a transient, self-limiting viral infection of the thyroid that occurs some weeks after a viral upper respiratory tract infection. Granulomas are present in the thyroid, hence the name.

It’s a moderately frequent disorder with seasonal fluctiations. It mostly affects middle-aged females.

Clinical features

The symptoms are usually preceded by an upper respiratory tract infection a few weeks prior. The typical symptoms of de Quervain thyroiditis include:

• Neck pain irradiating to the ear
• Painful goitre
• Fever
• Malaise

As in other cases of thyroiditis, there is an initial phase of thyrotoxicosis followed by a later phase of hypothyroidism.

Diagnosis and evaluation

Diagnosis is based on:

• Typical clinical features
• Ultrasound findings (inhomogenous, hypoechogenic thyroid)
• Normal leukocyte count
• Extremely high ESR
• Initial thyrotoxicosis followed by hypothyroidism
• No anti-thyroid antibodies

Radioactive iodine uptake test shows low iodine uptake, but this test is rarely indicated.

Treatment

For management of pain, NSAIDs are used. If insufficient, a short course of corticosteroids lasting 2 – 3 months is effective.

In the thyrotoxic phase, beta blockers may be useful for symptomatic therapy, while in the hypothyroid phase thyroxine substitution is indicated.

Prognosis

The thyrotoxicosis rapidly decreases and progresses to hypothyroidism, which is transient and normalises over 6 months in most cases. 10% retain permanent hypothyroidism.