Subacute Thyroiditis / De Quervain’s Thyroiditis (Part 1)

3d rendered illustration of the male larynx - cancer

  • Subacute thyroiditis (like painless sporadic and postpartum thyroiditis):
    • Is a spontaneous remitting inflammatory disorder of the thyroid:
      • That may last for weeks to months.
    • This disorder has a number of eponyms, including:
      • De Quervain’s thyroiditis
      • Giant cell thyroiditis
      • Pseudo-granulomatous thyroiditis
      • Subacute painful thyroiditis
      • Subacute granulomatous thyroiditis
      • Acute simple thyroiditis
      • Noninfectious thyroiditis
      • Acute diffuse thyroiditis
      • Migratory “creeping” thyroiditis,
      • Pseudotuberculous thyroiditis
      • Viral thyroiditis
    • The first description of subacute thyroiditis was in:
      • 1895 by Mygind:
        • Who reported 18 cases of “thyroiditis akuta simplex
    • The pathology of subacute thyroiditis was first described:
      • In 1904 by Fritz De Quervain:
        • Whose name is associated with the disorder:
          • He showed giant cells and granulomatous-type changes in the thyroids of affected patients


  • Subacute thyroiditis:
    • Is the most common cause of:
      • The painful thyroid:
        • May account for up to 5% of clinical thyroid abnormalities
  • As with other thyroid disorders:
    • Women are more frequently affected than men:
      • 5 to 1
  • The peak incidence is in the:
    • Fourth and fifth decades of life (20 to 60 years of age):
      • This disorder is rarely observed in children and the elderly.
  • Although the term subacute thyroiditis connotes a temporal quality that could apply to any thyroidal inflammatory process of intermediate duration and severity:
    • It is actually referring specifically to the granulomatous appearance of the thyroid found on pathologic exam


  • Pathogenesis:
    • Infectious Association:
      • Although there is no clear evidence for a specific etiology:
        • Indirect evidence suggests that subacute thyroiditis:
          • May be caused by a viral infection of the thyroid
      • The condition is often preceded by a:
        • Prodromal phase of:
          • Myalgia
          • General malaise
          • Low-grade fevers
          • Fatigue
          • Frequently by an upper respiratory tract infection
      • It has been reported most frequently in:
        • The temperate zone:
          • Only rarely from other parts of the world
      • It has been found to occur seasonally:
        • The highest incidence is in the summer months:
          • July through September:
            • Which coincide with the peak of enterovirus:
              • Echovirus infection
              • Coxsackie virus A and B infection
      • The incidence rate has been shown to vary directly with:
        • Viral epidemics:
          • Specifically mumps:
            • The incidence of subacute thyroiditis has been found to be higher during these viral epidemics
            • Interestingly:
              • Antibodies to the mumps virus have even been detected in individuals with subacute thyroiditis who do not have clinical evidence of mumps
          • Subacute thyroiditis has also been associated with:
            • Measles
            • Influenza
            • The common cold
            • Adenovirus
            • Infectious mononucleosis
            • Coxsackie virus
            • Myocarditis
            • Cat scratch fever
            • St. Louis encephalitis
            • Hepatitis A
            • The parvovirus B19 infection:
              • Antibodies to Coxsackie virus, adenovirus, influenza, and mumps have been detected:
                • In the convalescent phase of this disease
              • Coxsackie virus is most commonly associated with subacute thyroiditis:
                • Coxsackie virus antibody titers have been shown to directly follow the course of the thyroid disease
      • Certain non-viral infections, including:
        • Q fever and malaria:
          • Have been associated with a clinical syndrome similar to subacute thyroiditis.
      • A case of subacute thyroiditis occurring simultaneously with:
        • Giant cell arteritis has been reported.
      • Another case of subacute thyroiditis developed during:
        • Alfa-interferon treatment for hepatitis C
    • Autoimmune Association:
      • Unlike painless or postpartum thyroiditis:
        • There is no clear association between subacute thyroiditis and autoimmune thyroid disease
        • Serum thyroid peroxidase and thyroglobulin antibodies levels:
          • Are usually normal
        • When described:
          • The levels of thyroid peroxidase and thyroglobulin antibodies:
            • Correlated with the phase of transient hypothyroidism
        • Antibodies to an un-purified thyroid preparation can be detected:
          • For up to 4 years after a bout of subacute thyroiditis
        • Antibodies to the thyrotropin (TSH) receptor:
          • Have been rarely detected during the course of subacute thyroiditis
          • In most studies:
            • There was no correlation between the presence of :
              • Thyrotropin receptor binding inhibitory immunoglobulin (TBII) or of thyrotropin receptor stimulating immunoglobulin and the thyrotoxic phase of the thyroiditis:
                • On the other hand:
                  • There has been some correlation between thyroid-blocking antibodies and the development of hypothyroidism
          • It is thought that the appearance of the TSH-receptor antibodies results from:
            • An immune response:
              • That occurs after there is damage to the thyrocytes:
                • Specifically membrane desquamation
        • Following recovery from the inflammatory process of subacute thyroiditis:
          • All immunologic phenomena disappear:
            • The transitory immunologic markers that are observed during the course of subacute thyroiditis:
              • Appear to occur in response to the release of antigenic material from the thyroid
    • Genetic Association:
      • There is an apparent genetic predisposition for subacute thyroiditis:
        • With HLA-Bw 35 reported in all ethnic groups:
          • The relative risk of HLA-Bw 35 in subacute thyroiditis:
            • Is high:
              • Ranging from 8 to 56
        • Additional evidence for genetic susceptibility is the:
          • Simultaneous development of subacute thyroiditis in identical twins heterozygous for the HLA-Bw 35 haplotypes
        • A weak association of subacute thyroiditis with:
          • HLA-DRw8 has been reported in Japanese patients


#Arrangoiz #CancerSurgeon #ThyroidSurgeon #ParathyroidSurgeon #HeadandNeckSurgeon #ThyroidExpert #SurgicalOncologist #EndocrineSurgery #MountSinaiMedicalCenter #Miami #ThyroidNodule #deQuervain’sthyroiditis #Subacuethyroiditis

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s