Granulomatous thyroiditis

Granulomatous thyroiditis
Updated: 12/13/2018
© Jun Wang, MD, PhD

General features
  • AKA de Quervain's thyroiditis, subacute granulomatous thyroiditis
  • Most common cause of thyroid pain
  • Painful swallowing (odynophagia), sore throat, thyroid region tenderness, fever, fatigue, malaise
  • May be associated with systemic viral infection
  • Usually self limited, resolves in 6-8 weeks with transient hypothyroidism
Key laboratory findings
  • Early: Elevated T3 and T4, low radioactive iodine uptake
  • Late: Hypothyroidism and anti-thyroid antibodies
Pathological features
  • Focal to diffuse enlargement of thyroid gland
  • Early: neutrophils and destruction of follicles with colloid depletion
  • Later: noncaseating granulomas surround follicles and engulf colloid
  • Late: fibrosis
Treatment
  • Pain management: NSAID or corticosteroid
  • Hyperthyroidism management: Beta blockers, etc
  • Hypothyroidism management: Hormone replacement, etc



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