| De Quervain's thyroiditis | |
|---|---|
| Other names | Giant cell thyroiditis, subacute granulomatous thyroiditis |
 | |
| Micrograph showing a granuloma in subacute thyroiditis. H&E stain. | |
| Specialty | Endocrinology  |
De Quervain's thyroiditis, also known as subacute granulomatous thyroiditis or giant cell thyroiditis, is a self-limiting inflammatory illness of the thyroid gland.[1] De Quervain thyroiditis is characterized by fever, flu-like symptoms, a painful goiter, and neck pain. The disease has a natural history of four phases: thyroid pain, thyrotoxicosis, euthyroid phase, hypothyroid phase, and recovery euthyroid phase.
De Quervain's thyroiditis has been linked to various diseases, including mumps, adenovirus, and enterovirus. It may have a hereditary component, with two-thirds of patients having positive histocompatibility antigen (HLA) B35 results. Atypical cases have HLA B15/62 positivity, and it is more common in summer or fall months in people who test positive for HLA B67.
De Quervain thyroiditis is diagnosed through clinical and test results, with laboratory features including elevated C-reactive protein and erythrocyte sedimentation rate. Thyroid function testing often shows decreased thyroid stimulating hormone and increased serum levels of triiodothyronine and thyroxine during the acute phase. Thyroid scans show minimal uptake during the acute phase due to disrupted thyroid follicles, but increase during recovery due to the thyroid gland's enhanced iodine trapping capacity. Thyroid ultrasonography typically shows thyroid gland enlargement and hypoechogenicity, while color Doppler ultrasonography may show low or normal vascular flow. Tissue diagnosis is rare, but fine needle aspiration may be helpful in questionable cases to differentiate unilateral involvement from bleeding into a cyst or tumor.
Treatment involves symptomatic medication, glucocorticoid medication for severe cases, and beta-adrenergic blockers for thyrotoxic symptoms. The condition typically resolves within three to six months. However, 20-56% of adult patients experience transient hypothyroidism, which can persist for years. Recurrent hypothyroidism is rare, occurring in about 2% of cases, and usually manifests within a year after diagnosis. Late recurrences have been reported.