⚠️ 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

🧾 Clinical Case Example – De Quervain’s Thyroiditis

A 42-year-old woman presents with severe anterior neck pain radiating to the jaw and ears, three weeks after a viral illness. She has a tender, firm thyroid, low-grade fever, and mild tachycardia. Bloods show suppressed TSH, raised T4/T3, and high ESR/CRP. Radioiodine uptake is low, confirming De Quervain’s subacute thyroiditis. She is treated with NSAIDs for pain and β-blockers for thyrotoxic symptoms, with steroids if severe. The condition is self-limiting, sometimes followed by a transient hypothyroid phase before recovery.

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DeQuervain's thyroiditis