Subacute Granulomatous Thyroiditis: What Patients Need to Know

Learning More about de Quervain's Thyroiditis / Subacute Thyroiditis

thyroiditis causes many symptoms
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The term thyroiditis refers generally to any disorder that involves inflammation of your thyroid gland. Your thyroid is the small, butterfly-shaped gland, located in the neck, that produces hormones that deliver oxygen and energy to your cells, tissues, organs, and glands throughout the body.

Thyroiditis is typically divided into two broad categories -- painless thyroiditis and painful thyroiditis.

These two categories gauge the involve the level of pain you experience with the different types of thyroiditis. 

Among the category of painful types of thyroiditis is a form known as subacute granulomatous thyroiditis. It also is known as subacute nonsuppurative thyroiditis, de Quervain's thyroiditis, or painful subacute thyroiditis.

While subacute granulomatous type of thyroiditis is not common, it is frequently the reason for pain in the thyroid area, or tenderness when pressure is applied to your thyroid or neck. The pain is due to inflammation of the gland. 

In addition to neck pain and tenderness, symptoms of subacute granulomatous thyroiditis also include difficulty swallowing or a fever. There may also be signs of infection, such as enlarged lymph nodes near the thyroid.

Less commonly, symptoms can include hoarseness, weakness, fatigue, nervousness, anxiety, heat intolerance, weight loss, sweating, diarrhea, tremors, and palpitations.

 

The cause of subacute granulomatous thyroiditis is thought to be a viral or bacterial infection.

It's thought that is more common in the fall and winter, occurring after upper respiratory tract infections.

The Typical Course of Subacute Granulomatous Thyroiditis

What can you expect if you have subacute granulomatous thyroiditis?

Researching more about the condition, I checked out an article that offers an overview of thyroiditis on UpToDate -- an electronic reference used by many physicians and patients and presents in-depth medical information.

"The clinical manifestations are commonly divided into a painful thyrotoxic phase following which thyroid hormone levels return to the normal range. As thyroid hormone stores are depleted, a hypothyroid phase is then observed. Finally, when thyroid gland synthesis and regulation return to normal, so do the serum thyroid hormone levels. Each phase typically lasts about four to six weeks.
In a follow-up study of 160 patients with subacute granulomatous thyroiditis seen at the Mayo Clinic, only 4 percent of the patients had a recurrence (6 to 21 years after the initial episode). Only 15 percent of patients eventually developed permanent hypothyroidism requiring levothyroxine therapy."

Diagnosing the condition involves a clinical examination, and tests results that help diagnose the condition may include a high thyroglobulin level, a low radioactive iodine uptake, low thyroid stimulating hormone (TSH) level, high Free T4 level, and high erythrocyte sedimentation rate (ESR).

Imaging tests may show inflammation of the gland or the lymph nodes near the gland. 

Typically, then, an episode of subacute granulomatous thyroiditis -- the thyrotoxic phase -- starts out with a period of hyperthyroidism that typically lasts from four to six weeks. The hyperthyroidism may be accompanied by neck pain or difficulty swallowing, and fever. Thyroid hormone levels then start to drop, becoming normal for about four weeks. After normalizing, the thyroid levels typically continue to decline, and you become hypothyroid, usually for a timeframe lasting from four to six weeks.

For treatment, if the primary complaint is pain or swelling, a non-steroidal anti-inflammatory drug (like aspirin or ibuprofen) may be recommended. If a bacterial infection is identified, you may be prescribed antibiotics as well. If you are experiencing significant hyperthyroid symptoms, a beta blocker called propranolol may be prescribed during your hyperthyroid phase of the condition. In some cases, thyroid hormone replacement medications -- such as levothyroxine -- may be given during the hypothyroid phase, to relieve symptoms.

Eventually, in most patients, the thyroid gland, and hormone production returns to normal.

The good news: You have a very low risk of a recurrence of subacute granulomatous thyroiditis.

The bad news: One long-term study found that in 15 percent of patients, their episode of subacute granulomatous thyroiditis is a sign that they will eventually end up becoming permanently hypothyroid, and require treatment.

What Should You Do? 

If you are diagnosed with subacute granulomatous thyroiditis, make sure that you have periodic follow-up evaluation during the hypothyroid phase. If you are prescribed thyroid hormone replacement medication, you should continue taking the medication until your physician has found that your thyroid levels have normalized. If you are taken off medication but have hypothyroidism symptoms -- such as fatigue, weight gain, depression, or hair loss, for example -- make sure you have your thyroid checked again, as you may be among the percentage of people who develop permanent hypothyroidism after subacute granulomatous thyroiditis, 

Want to learn more? See UpToDate's topic, "Overview of thyroiditis," for additional in-depth, medical information

Source:

Burman, Kenneth. Ross, Douglas. Martin, Kathryn. "Overview of thyroiditis." UpToDate. Accessed: August 22, 2008.

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