de Quervain's thyroiditis

Patients typically present with low-grade fever and flu-like symptoms such as sore throat, myalgia, arthralgia, and malaise, which are followed by high-grade fever, a painful, widespread goiter, and neck pain.{{cite journal | last1=Engkakul | first1=Pontipa | last2=Mahachoklertwattana | first2=Pat | last3=Poomthavorn | first3=Preamrudee | title=Eponym: de Quervain thyroiditis | journal=European Journal of Pediatrics | volume=170 | issue=4 | date=2011 | issn=0340-6199 | doi=10.1007/s00431-010-1306-4 | pages=427–431| pmid=20886353 }} The neck pain is usually unilateral at first, then spreads to the other side and can radiate to the ipsilateral jaw, ear, occiput, or chest.{{cite journal | last=Greene | first=James N. | title=Subacute thyroiditis | journal=The American Journal of Medicine | publisher=Elsevier BV | volume=51 | issue=1 | year=1971 | issn=0002-9343 | doi=10.1016/0002-9343(71)90327-5 | pages=97–108| pmid=4936649 }}{{cite journal | last=Volpé | first=Robert | title=The Management of Subacute (DeQuervain's) Thyroiditis | journal=Thyroid | volume=3 | issue=3 | date=1993 | issn=1050-7256 | doi=10.1089/thy.1993.3.253 | pages=253–255| pmid=8257868 }} Other symptoms, such as dysphagia and breathing difficulties caused by airway blockage, are uncommon.

The thyroid gland is extremely painful, rigid, and swollen, which can be symmetrical or asymmetrical. Approximately half of affected adolescents and two-thirds of adults have widespread thyroid gland involvement.{{cite journal | last1=Ogawa | first1=E. | last2=Katsushima | first2=Y. | last3=Fujiwara | first3=I. | last4=Iinuma | first4=K. | title=Subacute Thyroiditis in Children: Patient Report and Review of the Literature | journal=Journal of Pediatric Endocrinology and Metabolism | publisher=Walter de Gruyter GmbH | volume=16 | issue=6 | year=2003 | pages=897–900 | issn=2191-0251 | doi=10.1515/jpem.2003.16.6.897 | pmid=12948304 }} Thyroid nodules are seen in one-fourth of adult patients.{{cite journal | last1=Fatourechi | first1=Vahab | last2=Aniszewski | first2=Jaroslaw P. | last3=Fatourechi | first3=Guiti Z. Eghbali | last4=Atkinson | first4=Elizabeth J. | last5=Jacobsen | first5=Steven J. | title=Clinical Features and Outcome of Subacute Thyroiditis in an Incidence Cohort: Olmsted County, Minnesota, Study | journal=The Journal of Clinical Endocrinology & Metabolism | volume=88 | issue=5 | date=2003-05-01 | issn=0021-972X | doi=10.1210/jc.2002-021799 | pages=2100–2105| pmid=12727961 }} The surrounding skin is occasionally warm and erythematous. Cervical lymphadenopathy is rare. During the early stages of the condition, almost half of patients experience thyrotoxic symptoms such as anxiety, tachycardia, palpitation, and weight loss.{{cite journal | last1=Bindra | first1=Archana | last2=Braunstein | first2=Glenn D. | title=Thyroiditis | journal=American Family Physician | volume=73 | issue=10 | date=2006-05-15 | issn=0002-838X | pmid=16734054 | pages=1769–1776}}{{cite journal | last1=Pearce | first1=Elizabeth N. | last2=Farwell | first2=Alan P. | last3=Braverman | first3=Lewis E. | title=Thyroiditis | journal=New England Journal of Medicine | publisher=Massachusetts Medical Society | volume=348 | issue=26 | date=2003-06-26 | issn=0028-4793 | doi=10.1056/nejmra021194 | pages=2646–2655| pmid=12826640 }}

The typical natural history of de Quervain thyroiditis has four phases, beginning with thyroid discomfort and thyrotoxicosis, followed by a brief euthyroid phase, temporary hypothyroid phase, and recovery euthyroid phase.

De Quervain's thyroiditis has been linked to a variety of viral illnesses, including mumps,{{cite journal | last1=Eylan | first1=E. | last2=Zmucky | first2=R. | last3=Sheba | first3=Ch. | title=Mumps Virus and Subacute Thyroiditis | journal=The Lancet | volume=269 | issue=6978 | date=1957 | doi=10.1016/S0140-6736(57)91438-1 | pages=1062–1063| pmid=13429875 }} adenovirus,{{cite journal | last=BUCHTA | first=RICHARD M. | title=Subacute Thyroiditis in a 4½-Year-Old Girl | journal=Archives of Pediatrics & Adolescent Medicine | publisher=American Medical Association (AMA) | volume=134 | issue=11 | date=1980-11-01 | pages=1090–1091 | issn=1072-4710 | doi=10.1001/archpedi.1980.02130230068019 | pmid=7435469 }} Epstein-Barr virus,{{cite journal | last1=Volta | first1=Cecilia | last2=Carano | first2=Nicola | last3=Street | first3=Maria Elisabeth | last4=Bernasconi | first4=Sergio | title=Atypical Subacute Thyroiditis Caused by Epstein-Barr Virus Infection in a Three-Year-Old Girl | journal=Thyroid | volume=15 | issue=10 | date=2005 | issn=1050-7256 | doi=10.1089/thy.2005.15.1189 | pages=1189–1191| hdl=11381/1444490 | hdl-access=free }} cytomegalovirus,{{cite journal | last1=Al Maawali | first1=A. | last2=Al Yaarubi | first2=S. | last3=Al Futaisi | first3=A. | title=An Infant with Cytomegalovirus-induced Subacute Thyroiditis | journal=Journal of Pediatric Endocrinology and Metabolism | publisher=Walter de Gruyter GmbH | volume=21 | issue=2 | year=2008 | issn=2191-0251 | doi=10.1515/jpem.2008.21.2.191 | page=}} coxsackievirus,{{cite journal | last1=Brouqui | first1=P. | last2=Raoult | first2=D. | last3=Conte-Devolx | first3=B. | title=Coxsackie Thyroiditis | journal=Annals of Internal Medicine | publisher=American College of Physicians | volume=114 | issue=12 | date=1991-06-15 | issn=0003-4819 | doi=10.7326/0003-4819-114-12-1063_2 | pages=1063–1064| pmid=1851403 }} influenza, echovirus,{{cite journal | last1=Volpé | first1=Robert | last2=Row | first2=Vas V. | last3=Ezrin | first3=Calvin | title=Circulating Viral and Thyroid Antibodies in Subacute Thyroiditis 1 | journal=The Journal of Clinical Endocrinology & Metabolism | volume=27 | issue=9 | date=1967 | issn=0021-972X | doi=10.1210/jcem-27-9-1275 | pages=1275–1284| pmid=4292248 }} and enterovirus.{{cite journal | last1=Desailloud | first1=Rachel | last2=Hober | first2=Didier | title=Viruses and thyroiditis: an update | journal=Virology Journal | volume=6 | issue=1 | date=2009 | issn=1743-422X | pmid=19138419 | pmc=2654877 | doi=10.1186/1743-422X-6-5 | doi-access=free | page=5}}

Furthermore, the development of de Quervain thyroiditis may have a hereditary component. About two thirds of patients with de Quervain thyroiditis were found to have positive histocompatibility antigen (HLA) B35 results.{{cite journal | last1=Bech | first1=Karine | last2=Lumholtz | first2=Bo | last3=Nerup | first3=Jørn | last4=Thomsen | first4=Mogens | last5=Platz | first5=Per | last6=Ryder | first6=Lars P. | last7=Svejgaard | first7=Arne | last8=Siersbæk-Nielsen | first8=Kaj | last9=Hansen | first9=Jens Mølholm | last10=Larsen | first10=Jørgen Hannover | title=HLA Antigens in Graves' Disease | journal=Acta Endocrinologica | volume=86 | issue=3 | date=1977 | issn=0804-4643 | doi=10.1530/acta.0.0860510 | pages=510–516| pmid=72471 }}{{cite journal | last1=NYULASSY | first1=ŠTEFAN | last2=HNILICA | first2=PETER | last3=BUC | first3=MILAN | last4=GUMAN | first4=MILAN | last5=HIRSCHOVÁ | first5=VIERA | last6=JÁN | first6=ŠTEFANOVIC | title=Subacute (de Quervain's) Thyroiditis: Association with HLA-Bw35 Antigen and Abnormalities of the Complement System, Immunoglobulins and Other Serum Proteins | journal=The Journal of Clinical Endocrinology & Metabolism | publisher=The Endocrine Society | volume=45 | issue=2 | year=1977 | issn=0021-972X | doi=10.1210/jcem-45-2-270 | pages=270–274| pmid=885992 }} Furthermore, it was found that identical twins who were heterozygous for the HLA B35 haplotype also developed de Quervain thyroiditis at the same time.{{cite journal | last1=RUBIN | first1=ROBERT A. | last2=GUAY | first2=ANDRÉ T. | title=Susceptibility to Subacute Thyroiditis Is Genetically Influenced: Familial Occurrence in Identical Twins | journal=Thyroid | publisher=Mary Ann Liebert Inc | volume=1 | issue=2 | year=1991 | issn=1050-7256 | doi=10.1089/thy.1991.1.157 | pages=157–161| pmid=1822362 }} Atypical cases of de Quervain thyroiditis have also been documented to have HLA B15/62 positivity,{{cite journal | last1=DE BRUIN | first1=TJERK W. A. | last2=RIEKHOFF | first2=FRANS P. M. | last3=DE BOER | first3=JOHANNES J. | title=An Outbreak of Thyrotoxicosis due to Atypical Subacute Thyroiditis* | journal=The Journal of Clinical Endocrinology & Metabolism | publisher=The Endocrine Society | volume=70 | issue=2 | year=1990 | issn=0021-972X | doi=10.1210/jcem-70-2-396 | pages=396–402| pmid=2298855 }} and summer or fall months are when de Quervain thyroiditis is more common in people who test positive for HLA B67.{{cite journal | last1=Ohsako | first1=N | last2=Tamai | first2=H | last3=Sudo | first3=T | last4=Mukuta | first4=T | last5=Tanaka | first5=H | last6=Kuma | first6=K | last7=Kimura | first7=A | last8=Sasazuki | first8=T | title=Clinical characteristics of subacute thyroiditis classified according to human leukocyte antigen typing. | journal=The Journal of Clinical Endocrinology & Metabolism | publisher=The Endocrine Society | volume=80 | issue=12 | year=1995 | issn=0021-972X | doi=10.1210/jcem.80.12.8530615 | pages=3653–3656| pmid=8530615 }}

It's still unclear exactly what causes de Quervain thyroiditis. According to available data, it is not an autoimmune illness. Still, the most likely cause is a viral infection. One theory for the pathophysiology of virus-associated thyroiditis is that thyroid follicular cell destruction results from cytotoxic T cell identification of viral and cell antigens presented as a complex.{{cite journal | last1=Kojima | first1=Masaru | last2=Nakamura | first2=Shigeo | last3=Oyama | first3=Tetsunari | last4=Sugihara | first4=Shiro | last5=Sakata | first5=Noriyuki | last6=Masawa | first6=Nobuhide | title=Cellular Composition of Subacute Thyroiditis. An Immunohistochemical Study of Six Cases | journal=Pathology — Research and Practice | publisher=Elsevier BV | volume=198 | issue=12 | year=2002 | issn=0344-0338 | doi=10.1078/0344-0338-00344 | pages=833–837| pmid=12608662 }}

The most common methods for diagnosing de Quervain thyroiditis are clinical and test results. Elevations of C-reactive protein and erythrocyte sedimentation rate are laboratory features of the condition. While typically normal, the blood leukocyte count may be slightly increased. There may be anemia that is normochromic and normocytic. Thyroid function testing frequently reveals decreased thyroid stimulating hormone (TSH) and increased serum levels of triiodothyronine (T3) and thyroxine (T4) during the acute phase of the disease. The intrathyroidal T3 and T4 levels are often reflected by the T3 to T4 ratio, which is typically less than 20 (ng/dL divided by μg/dL).{{cite journal | last1=AMINO | first1=NOBUYUKI | last2=YABU | first2=YUKIKO | last3=MIKI | first3=TETSURO | last4=MORIMOTO | first4=SHIGETO | last5=KUMAHARA | first5=YUICHI | last6=MORI | first6=HIDEMITSU | last7=IWATANI | first7=YOSHINORI | last8=NISHI | first8=KEIKO | last9=NAKATANI | first9=KIYOMI | last10=MIYAI | first10=KIYOSHI | title=Serum Ratio of Triiodothyronine to Thyroxine, and Thyroxine-Binding Globulin and Calcitonin Concentrations in Graves' Disease and Destruction- Induced Thyrotoxicosis* | journal=The Journal of Clinical Endocrinology & Metabolism | publisher=The Endocrine Society | volume=53 | issue=1 | year=1981 | issn=0021-972X | doi=10.1210/jcem-53-1-113 | pages=113–116| pmid=6165731 }} Nearly all patients have increased serum thyroglobulin, which is consistent with follicular destruction.{{cite journal | last1=Madeddu | first1=G. | last2=Casu | first2=A. R. | last3=Costanza | first3=C. | last4=Marras | first4=G. | last5=Arras | first5=M. L. | last6=Marrosu | first6=A. | last7=Langer | first7=M. | title=Serum thyroglobulin levels in the diagnosis and follow-up of subacute 'painful' thyroiditis. A sequential study | journal=Archives of Internal Medicine | volume=145 | issue=2 | date=1985 | issn=0003-9926 | pmid=3977482 | pages=243–247| doi=10.1001/archinte.1985.00360020063012 }}

Thyroid scans using technetium (99mTc) pertechnetate or RAIU usually show minimal uptake during the acute phase. This happens when thyroid follicles are disrupted, which impairs iodine trapping. Thyroid scan uptake increases throughout the recovery phase due to the thyroid gland's enhanced capacity to trap iodine, which eventually returns to normal after full recovery.

Thyroid gland enlargement and a region of hypoechogenicity that correlates to the inflammatory area are typically seen on thyroid ultrasonography.{{cite journal | last1=OMORI | first1=Nariko | last2=OMORI | first2=Kazue | last3=TAKANO | first3=Kazue | title=Association of the Ultrasonographic Findings of Subacute Thyroiditis with Thyroid Pain and Laboratory Findings | journal=Endocrine Journal | publisher=Japan Endocrine Society | volume=55 | issue=3 | year=2008 | issn=0918-8959 | doi=10.1507/endocrj.k07e-163 | pages=583–588| pmid=18490832 }} Low or normal vascular flow may be shown by color Doppler ultrasonography.{{cite journal | last1=HIROMATSU | first1=YUJI | last2=ISHIBASHI | first2=MASATOSHI | last3=MIYAKE | first3=IKUYO | last4=SOYEJIMA | first4=ERI | last5=YAMASHITA | first5=KIMIKO | last6=KOIKE | first6=NORIMASA | last7=NONAKA | first7=KYOHEI | title=Color Doppler Ultrasonography in Patients with Subacute Thyroiditis | journal=Thyroid | publisher=Mary Ann Liebert Inc | volume=9 | issue=12 | year=1999 | issn=1050-7256 | doi=10.1089/thy.1999.9.1189 | pages=1189–1193| pmid=10646657 }}

Rarely is tissue diagnosis required. Fine needle aspiration may be helpful in questionable cases, such as the area of pain restricted to a single nodule or confined area, to differentiate unilateral involvement from bleeding into a cyst or tumor.{{cite journal | last=Walfish | first=P. G. | title=Thyroiditis | journal=Current Therapy in Endocrinology and Metabolism | volume=6 | date=1997 | issn=0831-652X | pmid=9174718 | pages=117–122}}

The goals of treatment are to lessen hyperthyroid symptoms and relieve discomfort. Pain control only necessitates symptomatic treatment with non-steroidal anti-inflammatory medications or aspirin. Severely sick individuals may benefit from glucocorticoid medication, which often produces a substantial response in 24 to 48 hours. Thyrotoxic symptoms are managed with beta-adrenergic blockers such atenolol and propranolol.

De Quervain thyroiditis is a self-limiting condition that often goes away without any problems in three to six months. Regardless of the severity of the disease or the type of treatment used, 20–56% of adult patients experienced transient hypothyroidism a few weeks after the hyperthyroid period.{{cite journal | last1=Benbassat | first1=C. A. | last2=Olchovsky | first2=D. | last3=Tsvetov | first3=G. | last4=Shimon | first4=I. | title=Subacute thyroiditis: Clinical characteristics and treatment outcome in fifty-six consecutive patients diagnosed between 1999 and 2005 | journal=Journal of Endocrinological Investigation | publisher=Springer Science and Business Media LLC | volume=30 | issue=8 | year=2007 | issn=0391-4097 | doi=10.1007/bf03347442 | pages=631–635| pmid=17923793 }} Though it only happens in 5–15% of cases, persistent hypothyroidism can develop years after the diagnosis.{{cite journal | last1=Lio | first1=Serafino | last2=Pontecorvi | first2=Alfredo | last3=Caruso | first3=Michela | last4=Monaco | first4=Fabrizio | last5=D'Armiento | first5=Massimo | title=Transitory subclinical and permanent hypothyroidism in the course of subacute thyroiditis (de Quervain) | journal=Acta Endocrinologica | publisher=Oxford University Press (OUP) | volume=106 | issue=1 | year=1984 | issn=0804-4643 | doi=10.1530/acta.0.1060067 | pages=67–70| pmid=6428116 }} Recurrent de Quervain thyroiditis is rare, occurring in about 2% of cases, and usually manifests again within a year after diagnosis. But there have also been reports of late recurrences after several years.{{cite journal | last1=Nishihara | first1=Eijun | last2=Ohye | first2=Hidemi | last3=Amino | first3=Nobuyuki | last4=Takata | first4=Kazuna | last5=Arishima | first5=Takeshi | last6=Kudo | first6=Takumi | last7=Ito | first7=Mitsuru | last8=Kubota | first8=Sumihisa | last9=Fukata | first9=Shuji | last10=Miyauchi | first10=Akira | title=Clinical Characteristics of 852 Patients with Subacute Thyroiditis before Treatment | journal=Internal Medicine | publisher=Japanese Society of Internal Medicine | volume=47 | issue=8 | year=2008 | issn=0918-2918 | doi=10.2169/internalmedicine.47.0740 | pages=725–729| pmid=18421188 | doi-access=free }}{{cite journal | last1=Iitaka | first1=M | last2=Momotani | first2=N | last3=Ishii | first3=J | last4=Ito | first4=K | title=Incidence of subacute thyroiditis recurrences after a prolonged latency: 24-year survey. | journal=The Journal of Clinical Endocrinology & Metabolism | publisher=The Endocrine Society | volume=81 | issue=2 | year=1996 | issn=0021-972X | doi=10.1210/jcem.81.2.8636251 | pages=466–469| pmid=8636251 | doi-access=free }}

Subacute or De Quervain thyroiditis is an unusual diagnosis, occurring in 12.1 out of 100,000 people annually.{{cite journal | last1=Frates | first1=Mary C. | last2=Marqusee | first2=Ellen | last3=Benson | first3=Carol B. | last4=Alexander | first4=Erik K. | title=Subacute Granulomatous (de Quervain) Thyroiditis: Grayscale and Color Doppler Sonographic Characteristics | journal=Journal of Ultrasound in Medicine | volume=32 | issue=3 | date=2013 | doi=10.7863/jum.2013.32.3.505 | pages=505–511| pmid=23443191 }} Children are rarely affected by the De Quervain thyroiditis. With a female-to-male ratio of 4–7:1, females are more likely to be impacted than males.

De Quervain thyroiditis was originally reported in 1895 by Mygind.{{cite journal | last=Mygind | first=Holger | title=Thyroiditis Acuta Simplex. | journal=The Journal of Laryngology, Rhinology, and Otology | publisher=Cambridge University Press (CUP) | volume=9 | issue=3 | year=1895 | issn=1755-1463 | doi=10.1017/s1755146300152771 | pages=181–193}} Fritz de Quervain distinguished this illness from other types of thyroiditis in 1904 based on a histological discovery,{{cite journal | last=Quervain | first=F. de | title=Die akute, nicht eiterige Thyreoiditis : und die Beteiligung der Schilddrüse an akuten Intoxikationen und Infektionen überhaupt | journal=(No Title) | date=2024-07-02 |url=https://cir.nii.ac.jp/crid/1130000796679746560 | language=la | access-date=2024-07-03 | page=}} and de Quervain and Giordanengo confirmed the diagnosis in 1936.{{cite journal |last1=Quervain |first1=F |last2=Giordanengo |first2=G |title=Die akute und subakute nicht eiterige Thyreoiditis |journal=Mitt Grenzgeb Med Chir |date=1936 |volume=44 |pages=538–590}}

{{reflist}}

• {{cite journal | last1=Ranganath | first1=Rohit | last2=Shaha | first2=Manish A. | last3=Xu | first3=Bin | last4=Migliacci | first4=Jocelyn | last5=Ghossein | first5=Ronald | last6=Shaha | first6=Ashok R. | title=de Quervain's thyroiditis: A review of experience with surgery | journal=American Journal of Otolaryngology | volume=37 | issue=6 | date=2016 | pmid=27686396 | pmc=5574176 | doi=10.1016/j.amjoto.2016.08.006 | pages=534–537 | ref=none}}
• {{cite journal | last1=Kong | first1=Mark | last2=La Porte | first2=Sarah | title=Case Report: De Quervain's Thyroiditis as a Long-Term Sequelae Complication to SARS-CoV-2 Infection | journal=Case Reports in Acute Medicine | volume=4 | issue=2 | date=2021-07-09 | issn=2504-5288 | pmc=8339010 | doi=10.1159/000517705 | pages=64–70 | ref=none}}

• {{cite web | last1=Tabassom | first1=Ayesha | last2=Chippa | first2=Venu | last3=Edens | first3=Mary Ann | title=De Quervain Thyroiditis | publisher=StatPearls Publishing | date=2023-07-17 | pmid=30252322 |url=https://www.ncbi.nlm.nih.gov/books/NBK526066/ | ref=none}}
• {{cite web | title=Subacute Thyroiditis | website=Penn Medicine |url=https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/subacute-thyroiditis | ref=none}}

{{Medical resources

| ICD11 = {{ICD11|5A03.1}}

| ICD10 = {{ICD10|E06.1}}

| ICD10CM =

| ICD9 = {{ICD9|245.1}}

| ICDO =

| OMIM =

| MeshID = D013968

| DiseasesDB = 3474

| SNOMED CT = 428041004

| Curlie =

| MedlinePlus = 000375

| eMedicineSubj = article

| eMedicineTopic = 125648

| PatientUK =

| NCI =

| GeneReviewsNBK =

| GeneReviewsName =

| NORD =

| GARDNum =

| GARDName =

| RP = 30316

| AO =

| WO =

| OrthoInfo =

| Orphanet =

| Scholia = Q16485

| OB =

}}

{{Thyroid disease}}

{{DEFAULTSORT:De Quervain's Thyroiditis}}

Category:Thyroid disease