Makindo Medical Notes

⚠️ It is generally advised not to treat the thyroid hormone phases directly (hyper- or hypothyroid) as De Quervain's thyroiditis is often self-limiting. ✅ Management is focused on symptomatic relief.

📖 About

• De Quervain's Thyroiditis (a.k.a. subacute granulomatous thyroiditis, painful thyroiditis) is a self-resolving inflammatory disorder.
• 🦠 Often viral in origin → transient hyperthyroidism → possible hypothyroidism → eventual recovery.
• Patients present with thyroid pain + systemic inflammation.

🧬 Aetiology

• Commonly triggered by a viral illness:
  • Coxsackievirus
  • EBV
  • Mumps, measles, influenza
  • Adenovirus, echovirus
• Genetic predisposition: linked to HLA-B35.

🩺 Clinical Presentation

• ⏳ Often follows an upper respiratory infection (3–6 weeks earlier).
• Thyroid pain (radiates to jaw/ear) + tenderness on palpation.
• Other features:
  • Dysphagia, hoarseness
  • Fever, malaise, myalgia
  • Transient hyperthyroidism: anxiety, sweating, weight loss
• Natural course:
  • Acute phase (3–6 wks): Pain + hyperthyroidism
  • Subacute phase (2–4 wks): Euthyroid
  • Recovery: Often transient hypothyroid → normal function

🔎 Differential Diagnosis

• Hashimoto’s thyroiditis: High anti-TPO antibodies (>500 U/mL)
• Graves’ disease: Diffuse goitre, exophthalmos, ↑ diffuse radioactive iodine uptake
• Suppurative thyroiditis: Acute bacterial infection (pain + systemic sepsis)

🧪 Investigations

• Bloods: Raised ESR/CRP, ± leukocytosis
• TFTs:
  • Hyperthyroid phase → ↑T4/T3, suppressed TSH
  • Hypothyroid phase → ↓T4/T3, ↑TSH
• Radioactive iodine uptake: Low/absent in hyperthyroid phase (helps distinguish from Graves’)

💊 Management

• NSAIDs: 1st-line for pain/inflammation (e.g., ibuprofen, naproxen)
• Glucocorticoids: Prednisolone 30–40 mg/day if severe pain or NSAID failure (taper over ~6 wks)
• Beta-blockers: Symptomatic control of hyperthyroid symptoms (palpitations, tremor)
• Thyroxine replacement: If hypothyroid phase is prolonged/severe
• 📅 Follow-up: Serial TFTs to ensure eventual recovery

📚 References

• Subacute, Granulomatous De Quervain's Thyroiditis