Thyroiditis (Subacute/Transient) or De Quervain’s thyroiditis


  • Self-limiting condition which characteristically has three clinical phases
    1. Hyperthyroidism
    2. Hypothyroidism
    3. Euthyroidism
  • May be a cause of up to 15% of patients with thyrotoxicosis and up to 10% of patients with hypothyroidism.
  • There are also three different pathological types of subacute thyroiditis
    • Subacute granulomatous thyroiditis (de Quervain’s or subacute painful)
    • Subacute Lymphocytic thyroiditis (painless)
    • Subacute post-partum thyroiditis
  • As with other thyroid conditions, women are more at risk than men (3-5:1).  Average age of onset is 30-50 years old.

Aetiology/Risk factors

  • Subacute granulomatous
    • Most commonly follows an episode of viral illness
    • There are genetic factors that may predispose e.g. HLA-B35
  • Lymphocytic
    • Thought to be, at least in part, an autoimmune process, as antibodies (in particular antimicrosomal antibodies and antithyroid peroxidase antibodies) are often present in these patients
    • Can also occur in patients receiving or having received amiodarone or interferon-α treatment. (can present >2 years later)
  • Post-partum
    • Also thought to be autoimmune in nature
    • Much rarer in countries with iodine-rich diets
  • Other causes include radiotherapy and infective thyroiditis (rare- only really ever seen in immunodeficient patients)


  • The inflammatory process occurs.  This causes swelling/enlargement of the thyroid gland.  As the process continues, the thyroid follicles are broken down and thyroid hormone is inadvertently released.
  • Hyperthyroid phase occurs at this stage.  As the amount of T3/T4 is depleted, patient typically then become euthyroid and then hypothyroid, before recovering to a euthyroid state.
  • Histologically, there is a mixture of acute, subacute and chronic granulomatous, inflammatory change associated with follicle destruction.


  • Typically, patients present with a prodromal illness or infection
    • May complain of flu-like symptoms e.g. fever, malaise, myalgia, sore-throat, anorexia, fatigue etc
    • May have been diagnosed with infection e.g. pharyngitis, measles, mumps etc
    • NB constitutional symptoms may continue with the thyroiditis (even if symptoms of specific infection had resolved)
  • Often the thyroid enlarges (often firm enlargement and diffuse)
    • In painful (granulomatous) thyroiditis, the thyroid is usually acutely painful/tender (gradual/sudden)
      • this can start on one site and spread or begin bilaterally
    • Other local symptoms that can occur include
      • dysphagia
      • hoarseness
  • NB in post-partum thyroiditis, there is firm, painless enlargement of the thyroid which can occur up to 6 months after birth
  • Symptoms of hyperthyroidism and/or hypothyroidism


  • FBC
    • WCC may or may not be raised.  CRP can be slightly elevated
  • Thyroid function tests
    • NB cf toxic nodular disease, if there is hyperthyroidism- fT4 is usually disproportionately elevated compared to fT3
  • Radioiodine scan (decreased uptake can distinguish thyroiditis from Grave’s disease – which may otherwise be indistinguishable from painless thyroiditis)


  • Because thyroiditis is often self-limiting, no treatment is routinely required (important to diagnose correctly over Graves regarding unnecessary treatment)
  • If the patient remains chronically hypothyroid after the episode, replacement thyroxine can be considered.
  • If acute hyperthyroid symptoms are really troublesome, beta-blockers can be used for symptomatic relief

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