Subacute (De Quervain's) Thyroiditis

Subacute thyroiditis is a temporary thyroid disease that can cause sudden onset of painful inflammation in the thyroid glands. Despite being temporary, it should still be taken seriously and kept under observation. Also known as granulomatous thyroiditis or De Quervain's thyroiditis, this condition most commonly occurs after a viral upper respiratory tract infection. It causes symptoms such as high fever, fatigue, and neck pain. However, these symptoms are generally confused with different infections like tonsillitis or pharyngitis. This confusion leads the patient to use antibiotics unnecessarily. However, antibiotic use does not provide improvement for these complaints.

Subacute thyroiditis is a type of non-microbial inflammation directly related to the thyroid gland. Among its most important features are pains affecting the front of the neck, spreading towards the jaw and ears. Subacute thyroiditis can be diagnosed with clinical history, imaging tests, laboratory tests, and physician examination. Op. Dr. İbrahim Çolhan, who serves his patients in Adana, explained what subacute thyroiditis is, its causes, symptoms, diagnosis, and treatment methods for you.

What is Subacute Thyroiditis? 

Subacute thyroiditis is a non-microbial, inflammatory condition. It causes cellular damage in the thyroid gland. This damage leads to hormones stored within the gland entering the bloodstream. As a result, it causes a temporary excessive increase in thyroid hormones. While some cases of subacute thyroiditis can fully recover, in others, the process may be prolonged and lead to the development of permanent thyroid insufficiency.

This condition shows seasonal characteristics and is commonly seen in autumn and winter months. However, it is not contagious.

Who Gets Subacute Thyroiditis? 

• Subacute thyroiditis is more commonly observed in the 30 to 50 age group.
• The incidence in women is four times higher compared to men.
• Genetic predisposition increases the risk of subacute thyroiditis.
• Individuals who have recently had a viral infection are more likely to develop subacute thyroiditis.
• In addition to all these, statistics have also shown an increase in subacute thyroiditis cases during the COVID-19 pandemic.

What Are the Symptoms of Subacute Thyroiditis?

A significant majority of subacute thyroiditis patients exhibit the following symptoms:

• Pain and tenderness felt in the front of the neck
• High fever
• Pain spreading towards the ears and jaw
• Feeling of weakness
• Palpitations
• Sweating
• Loss of appetite
• Involuntary weight loss
• Hoarseness
• Difficulty swallowing
• Muscle and joint pains
• State of mental restlessness

In later stages, thyroid hormone levels may decrease, and symptoms of hypothyroidism may be observed. These symptoms include:

• Constipation
• Dry skin
• Hair loss
• Weight gain
• Fatigue
• Depressed mood

What Causes Subacute Thyroiditis? 

The most common cause of subacute thyroiditis is the immune system destroying the thyroid gland in response to a viral infection. The causative microorganism does not directly target the thyroid gland. However, if the immune system overreacts, thyroid tissue can be affected. Therefore, the most fundamental cause is an immune response after a viral infection.

Main Causes of Subacute Thyroiditis: 

• Viral upper respiratory tract infections
• Seasonally occurring adenoviruses and influenza-like viruses
• Immune system response after COVID-19 infection
• Genetic predisposition
• Over-sensitivity of the immune system

How is Subacute Thyroiditis Diagnosed? 

The most important factor in diagnosing subacute thyroiditis is for the physician to suspect its presence. This is because patients generally act incorrectly, believing they have tonsillitis or pharyngitis.

The methods used in the diagnosis of Subacute Thyroiditis are as follows:

• Laboratory tests
• Thyroid Ultrasonography
• Thyroid Scintigraphy
• Physical Examination

How Does Subacute Thyroiditis Progress? 

The course of the disease generally progresses in three stages:

Thyrotoxicosis Period Lasting One to Three Months

• During this period, the level of thyroid hormones in the blood shows an excessive increase.
• Symptoms such as palpitations, diarrhea, restlessness, and sweating are observed in the patient.
• It is accompanied by high fever, a feeling of exhaustion, and muscle and joint pains.

Euthyroid Phase It is a temporary normalization period.

During this process, hormone levels temporarily return to normal.

Hypothyroid Phase

• In this stage, the thyroid gland becomes insufficient in hormone production.
• Symptoms such as weight gain, depressed mood, constipation, and fatigue are observed in the patient.

Permanent hypothyroidism may occur in some patients.

How is Subacute Thyroiditis Treated?

The aim in treating subacute thyroiditis is to control symptoms and support the patient's natural healing process. For this purpose:

• The patient restricts their level of physical exertion.
• Frequent contact with the neck area should be avoided.
• Medication applications aimed at relieving pain and reducing high fever.
• Beta-blockers are used to alleviate symptoms of thyrotoxicosis such as palpitations, tremors, and an irritable mood.
• It is recommended to check the patient's hormone levels every three to four weeks.
• If cortisone treatment has been applied, cortisone use should be discontinued slowly and in a controlled manner.
• In recurrent cases, longer-term follow-up may be required.

Subacute Thyroiditis and Risk of Permanent Damage 

Subacute thyroiditis can often show complete recovery. However, in fifteen to twenty percent of cases, permanent hypothyroidism may occur. This condition generally occurs in;

• Individuals with positive thyroid antibodies
• Individuals with a prior history of Hashimoto's thyroiditis
• And those showing significant signs of damage in thyroid gland ultrasonography.