Subacute Thyroiditis

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Subacute thyroiditis (like painless sporadic thyroiditis and postpartum thyroiditis):
    • Is a spontaneous remitting inflammatory disorder of the thyroid:
    • That may last for weeks to months (has a more sudden onset)
  • 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 (Hashimoto’s Thyroiditis is 8 to 9 / 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 decreased 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

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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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