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Acute and Subacute Thyroiditis

  • Karen M. Rothacker
  • John P. Walsh
Reference work entry
Part of the Endocrinology book series (ENDOCR)

Abstract

The term thyroiditis refers to inflammation of the thyroid gland, which has many causes. The tempo of clinical presentation is used to classify thyroiditis into acute, subacute, and chronic types, but in practice there is considerable overlap. Acute forms of thyroiditis include acute infectious thyroiditis caused by bacterial or fungal infection (most commonly arising from a piriform sinus tract fistula or hematogenous spread) and radiation-induced and traumatic thyroiditis. Many types of thyroiditis may present in a subacute fashion, but the term subacute thyroiditis is generally reserved for a specific type of thyroiditis characterized pathologically by granulomatous inflammation and the presence of giant cells, which is thought to be precipitated by viral infection in genetically predisposed individuals. Acute infectious thyroiditis and subacute thyroiditis each present with painful anterior neck swelling and constitutional symptoms; careful clinical assessment, supported by judicious use of imaging and fine-needle aspiration biopsy, allows diagnostic differentiation. Thyroid dysfunction in subacute thyroiditis classically follows a triphasic course of hyperthyroidism, followed by hypothyroidism and eventual resolution to euthyroidism, but these phases are not all observed in all patients. In hyperthyroid patients, it can be difficult to distinguish clinically between subacute thyroiditis, lymphocytic thyroiditis, and Graves’ disease, and inflammatory markers, thyroid antibody measurement, and radionuclide imaging can be diagnostically helpful. The treatment of acute infectious thyroiditis is with systemic antimicrobial treatment and surgical drainage. For subacute thyroiditis, treatment is not always required; when it is warranted, nonsteroidal anti-inflammatory drugs or glucocorticoid treatment can be offered for the painful thyroiditis and beta-blockade for symptoms of thyrotoxicosis. Follow-up of thyroid function is recommended to ensure resolution.

Keywords

Thyroiditis Acute thyroiditis Infectious thyroiditis Piriform sinus tract fistula Radiation thyroiditis Traumatic thyroiditis Subacute thyroiditis De Quervain’s thyroiditis Subacute granulomatous thyroiditis 

References

  1. Aizawa T, Watanabe T, Suzuki N, Suzuki S, Miyamoto T, Ichikawa K, Oguchi M, Hashizume K. Radiation-induced painless thyrotoxic thyroiditis followed by hypothyroidism: a case report and literature review. Thyroid. 1998;8(3):273–5.CrossRefPubMedGoogle Scholar
  2. Al-Dajani N, Wootton SH. Cervical lymphadenitis, suppurative parotitis, thyroiditis, and infected cysts. Infect Dis Clin North Am. 2007;21(2):523–41, viii.CrossRefPubMedGoogle Scholar
  3. Amino N, Yabu Y, Miki T, Morimoto S, Kumahara Y, Mori H, Iwatani Y, Nishi K, Nakatani K, Miyai K. Serum ratio of triiodothyronine to thyroxine, and thyroxine-binding globulin and calcitonin concentrations in Graves’ disease and destruction-induced thyrotoxicosis. J Clin Endocrinol Metab. 1981;53(1):113–6.CrossRefPubMedGoogle Scholar
  4. Arao T, Okada Y, Torimoto K, Kurozumi A, Narisawa M, Yamamoto S, Tanaka Y. Prednisolone dosing regimen for treatment of subacute thyroiditis. J UOEH. 2015;37(2):103–10.CrossRefPubMedGoogle Scholar
  5. Assir MZ, Jawa A, Ahmed HI. Expanded dengue syndrome: subacute thyroiditis and intracerebral hemorrhage. BMC Infect Dis. 2012;12:240.CrossRefPubMedPubMedCentralGoogle Scholar
  6. Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA, Ross DS, Sosa JA, Stan MN. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pract. 2011;17(3):456–520.CrossRefPubMedGoogle Scholar
  7. Baidya A, Singha A, Bhattacharjee R, Dalal BS. Tuberculosis of the thyroid gland: two case reports. Oxf Med Case Rep. 2015;2015(4):262–4.CrossRefGoogle Scholar
  8. Benbassat CA, Olchovsky D, Tsvetov G, Shimon I. Subacute thyroiditis: clinical characteristics and treatment outcome in fifty-six consecutive patients diagnosed between 1999 and 2005. J Endocrinol Invest. 2007;30(8):631–5.CrossRefPubMedGoogle Scholar
  9. Bennedbaek FN, Gram J, Hegedus L. The transition of subacute thyroiditis to Graves’ disease as evidenced by diagnostic imaging. Thyroid. 1996;6(5):457–9.CrossRefPubMedGoogle Scholar
  10. Bennedbaek FN, Hegedus L. The value of ultrasonography in the diagnosis and follow-up of subacute thyroiditis. Thyroid. 1997;7(1):45–50.CrossRefPubMedGoogle Scholar
  11. Bonnema SJ, Hegedus L. Radioiodine therapy in benign thyroid diseases: effects, side effects, and factors affecting therapeutic outcome. Endocr Rev. 2012;33(6):920–80.CrossRefPubMedGoogle Scholar
  12. Bouillet B, Petit JM, Piroth L, Duong M, Bourg JB. A case of subacute thyroiditis associated with primary HIV infection. Am J Med. 2009;122(4):e5–6.CrossRefPubMedGoogle Scholar
  13. Carle A, Pedersen IB, Knudsen N, Perrild H, Ovesen L, Rasmussen LB, Laurberg P. Epidemiology of subtypes of hyperthyroidism in Denmark: a population-based study. Eur J Endocrinol. 2011;164(5):801–9.CrossRefPubMedGoogle Scholar
  14. Carney JA, Moore SB, Northcutt RC, Woolner LB, Stillwell GK. Palpation thyroiditis (multifocal granulomatour folliculitis). Am J Clin Pathol. 1975;64(5):639–47.CrossRefPubMedGoogle Scholar
  15. Cherk MH, Kalff V, Yap KS, Bailey M, Topliss D, Kelly MJ. Incidence of radiation thyroiditis and thyroid remnant ablation success rates following 1110 MBq (30 mCi) and 3700 MBq (100 mCi) post-surgical 131I ablation therapy for differentiated thyroid carcinoma. Clin Endocrinol (Oxf). 2008;69(6):957–62.CrossRefGoogle Scholar
  16. Cunha BA, Chak A, Strollo S. Fever of unknown origin (FUO): de Quervain’s subacute thyroiditis with highly elevated ferritin levels mimicking temporal arteritis (TA). Heart Lung. 2010;39(1):73–7.CrossRefPubMedGoogle Scholar
  17. Desailloud R, Hober D. Viruses and thyroiditis: an update. Virol J. 2009;6:5.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Engkakul P, Mahachoklertwattana P, Poomthavorn P. Eponym: de Quervain thyroiditis. Eur J Pediatr. 2011;170(4):427–31.CrossRefPubMedGoogle Scholar
  19. Erdem N, Erdogan M, Ozbek M, Karadeniz M, Cetinkalp S, Ozgen AG, Saygili F, Yilmaz C, Tuzun M, Kabalak T. Demographic and clinical features of patients with subacute thyroiditis: results of 169 patients from a single university center in Turkey. J Endocrinol Invest. 2007;30(7):546–50.CrossRefPubMedGoogle Scholar
  20. Espiritu RP, Dean DS. Parathyroidectomy-induced thyroiditis. Endocr Pract. 2010;16(4):656–9.CrossRefPubMedGoogle Scholar
  21. Fatourechi V, Aniszewski JP, Fatourechi GZ, Atkinson EJ, Jacobsen SJ. Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted County, Minnesota, study. J Clin Endocrinol Metab. 2003;88(5):2100–5.CrossRefPubMedGoogle Scholar
  22. Goldani LZ, Zavascki AP, Maia AL. Fungal thyroiditis: an overview. Mycopathologia. 2006;161(3):129–39.CrossRefPubMedGoogle Scholar
  23. Hamaguchi E, Nishimura Y, Kaneko S, Takamura T. Subacute thyroiditis developed in identical twins two years apart. Endocr J. 2005;52(5):559–62.CrossRefPubMedGoogle Scholar
  24. Hendrick JW. Diagnosis and management of thyroiditis. J Am Med Assoc. 1957;164(2):127–33.CrossRefPubMedGoogle Scholar
  25. Iitaka M, Momotani N, Ishii J, Ito K. Incidence of subacute thyroiditis recurrences after a prolonged latency: 24-year survey. J Clin Endocrinol Metab. 1996;81(2):466–9.PubMedGoogle Scholar
  26. Iitaka M, Momotani N, Hisaoka T, Noh JY, Ishikawa N, Ishii J, Katayama S, Ito K. TSH receptor antibody-associated thyroid dysfunction following subacute thyroiditis. Clin Endocrinol (Oxf). 1998;48(4):445–53.CrossRefGoogle Scholar
  27. Izumi Y, Hidaka Y, Tada H, Takano T, Kashiwai T, Tatsumi KI, Ichihara K, Amino N. Simple and practical parameters for differentiation between destruction-induced thyrotoxicosis and Graves’ thyrotoxicosis. Clin Endocrinol (Oxf). 2002;57(1):51–8.CrossRefGoogle Scholar
  28. Kim KH, Sung MW, Koh TY, Oh SH, Kim IS. Pyriform sinus fistula: management with chemocauterization of the internal opening. Ann Otol Rhinol Laryngol. 2000;109(5):452–6.CrossRefPubMedGoogle Scholar
  29. Kitchener MI, Chapman IM. Subacute thyroiditis: a review of 105 cases. Clin Nucl Med. 1989;14(6):439–42.CrossRefPubMedGoogle Scholar
  30. Kon YC, DeGroot LJ. Painful Hashimoto’s thyroiditis as an indication for thyroidectomy: clinical characteristics and outcome in seven patients. J Clin Endocrinol Metab. 2003;88(6):2667–72.CrossRefPubMedGoogle Scholar
  31. Kramer AB, Roozendaal C, Dullaart RP. Familial occurrence of subacute thyroiditis associated with human leukocyte antigen-B35. Thyroid. 2004;14(7):544–7.CrossRefPubMedGoogle Scholar
  32. Kubota S, Nishihara E, Kudo T, Ito M, Amino N, Miyauchi A. Initial treatment with 15 mg of prednisolone daily is sufficient for most patients with subacute thyroiditis in Japan. Thyroid. 2013;23(3):269–72.CrossRefPubMedGoogle Scholar
  33. Luiz HV, Pereira BD, Silva TN, Veloza A, Matos C, Manita I, Cordeiro MC, Raimundo L, Portugal J. Thyroid tuberculosis with abnormal thyroid function – case report and review of the literature. Endocr Pract. 2013;19(2):e44–9.CrossRefPubMedGoogle Scholar
  34. Luotola K, Hyoty H, Salmi J, Miettinen A, Helin H, Pasternack A. Evaluation of infectious etiology in subacute thyroiditis – lack of association with coxsackievirus infection. APMIS. 1998;106(4):500–4.CrossRefPubMedGoogle Scholar
  35. Ma SG, Bai F, Cheng L. A novel treatment for subacute thyroiditis: administration of a mixture of lidocaine and dexamethasone using an insulin pen. Mayo Clin Proc. 2014;89(6):861–2.CrossRefPubMedGoogle Scholar
  36. Mai VQ, Glister BC, Clyde PW, Shakir KM. Palpation thyroiditis causing new-onset atrial fibrillation. Thyroid. 2008;18(5):571–3.CrossRefPubMedGoogle Scholar
  37. Majid U, Islam N. Thyroid tuberculosis: a case series and a review of the literature. J Thyroid Res. 2011;2011:359864.CrossRefPubMedPubMedCentralGoogle Scholar
  38. Mariotti S, Caturegli P, Piccolo P, Barbesino G, Pinchera A. Antithyroid peroxidase autoantibodies in thyroid diseases. J Clin Endocrinol Metab. 1990;71(3):661–9.CrossRefPubMedGoogle Scholar
  39. Martinez-Artola Y, Poncino D, Garcia ML, Munne MS, Gonzalez J, Garcia DS. Acute hepatitis E virus infection and association with a subacute thyroiditis. Ann Hepatol. 2015;14(1):141–2.PubMedGoogle Scholar
  40. Martino E, Buratti L, Bartalena L, Mariotti S, Cupini C, Aghini-Lombardi F, Pinchera A. High prevalence of subacute thyroiditis during summer season in Italy. J Endocrinol Invest. 1987;10(3):321–3.CrossRefPubMedGoogle Scholar
  41. Masuoka H, Miyauchi A, Tomoda C, Inoue H, Takamura Y, Ito Y, Kobayashi K, Miya A. Imaging studies in sixty patients with acute suppurative thyroiditis. Thyroid. 2011;21(10):1075–80.CrossRefPubMedGoogle Scholar
  42. McDermott MT, Kidd GS, Dodson Jr LE, Hofeldt FD. Radioiodine-induced thyroid storm. Case report and literature review. Am J Med. 1983;75(2):353–9.CrossRefPubMedGoogle Scholar
  43. Miyauchi A. Thyroid gland: a new management algorithm for acute suppurative thyroiditis? Nat Rev Endocrinol. 2010;6(8):424–6.CrossRefPubMedGoogle Scholar
  44. Miyauchi A, Inoue H, Tomoda C, Amino N. Evaluation of chemocauterization treatment for obliteration of pyriform sinus fistula as a route of infection causing acute suppurative thyroiditis. Thyroid. 2009;19(7):789–93.CrossRefPubMedGoogle Scholar
  45. Mizukoshi T, Noguchi S, Murakami T, Futata T, Yamashita H. Evaluation of recurrence in 36 subacute thyroiditis patients managed with prednisolone. Intern Med. 2001;40(4):292–5.CrossRefPubMedGoogle Scholar
  46. Mori K, Yoshida K, Funato T, Ishii T, Nomura T, Fukuzawa H, Sayama N, Hori H, Ito S, Sasaki T. Failure in detection of Epstein-Barr virus and cytomegalovirus in specimen obtained by fine needle aspiration biopsy of thyroid in patients with subacute thyroiditis. Tohoku J Exp Med. 1998;186(1):13–7.CrossRefPubMedGoogle Scholar
  47. Mou JW, Chan KW, Wong YS, Houben CH, Tam YH, Lee KH. Recurrent deep neck abscess and piriform sinus tract: a 15-year review on the diagnosis and management. J Pediatr Surg. 2014;49(8):1264–7.CrossRefPubMedGoogle Scholar
  48. Mygind H. Thyroiditis akuta simplex. J Laryngol Rhinol Otol. 1895;9:181–93.CrossRefGoogle Scholar
  49. Nishihara E, Ohye H, Amino N, Takata K, Arishima T, Kudo T, Ito M, Kubota S, Fukata S, Miyauchi A. Clinical characteristics of 852 patients with subacute thyroiditis before treatment. Intern Med. 2008;47(8):725–9.CrossRefPubMedGoogle Scholar
  50. Nishiyama K, Kozuka T, Higashihara T, Miyauchi K, Okagawa K. Acute radiation thyroiditis. Int J Radiat Oncol Biol Phys. 1996;36(5):1221–4.CrossRefPubMedGoogle Scholar
  51. Nyulassy S, Hnilica P, Buc M, Guman M, Hirschova V, Stefanovic J. Subacute (de Quervain’s) thyroiditis: association with HLA-Bw35 antigen and abnormalities of the complement system, immunoglobulins and other serum proteins. J Clin Endocrinol Metab. 1977;45(2):270–4.CrossRefPubMedGoogle Scholar
  52. Ohsako N, Tamai H, Sudo T, Mukuta T, Tanaka H, Kuma K, Kimura A, Sasazuki T. Clinical characteristics of subacute thyroiditis classified according to human leukocyte antigen typing. J Clin Endocrinol Metab. 1995;80(12):3653–6.CrossRefPubMedGoogle Scholar
  53. Paes JE, Burman KD, Cohen J, Franklyn J, McHenry CR, Shoham S, Kloos RT. Acute bacterial suppurative thyroiditis: a clinical review and expert opinion. Thyroid. 2010;20(3):247–55.CrossRefPubMedGoogle Scholar
  54. Pereira O, Prasad DS, Bal AM, McAteer D, Abraham P. Fatal descending necrotizing mediastinitis secondary to acute suppurative thyroiditis developing in an apparently healthy woman. Thyroid. 2010;20(5):571–2.CrossRefPubMedGoogle Scholar
  55. Rosenstein ED, Kramer N. Occult subacute thyroiditis mimicking classic giant cell arteritis. Arthritis Rheum. 1994;37(11):1618–20.CrossRefPubMedGoogle Scholar
  56. Ross DS. Radioiodine therapy for hyperthyroidism. N Engl J Med. 2011;364(6):542–50.CrossRefPubMedGoogle Scholar
  57. Samuels MH. Subacute, silent, and postpartum thyroiditis. Med Clin North Am. 2012;96(2):223–33.CrossRefPubMedGoogle Scholar
  58. Schofield PM, Keal EE. Subacute thyroiditis associated with Chlamydia psittaci infection. Postgrad Med J. 1986;62(723):33–4.CrossRefPubMedPubMedCentralGoogle Scholar
  59. Segni M, Turriziani I, di Nardo R, Pucarelli I, Serafinelli C. Acute suppurative thyroiditis treated avoiding invasive procedures in a child. J Clin Endocrinol Metab. 2011;96(10):2980–1.CrossRefPubMedGoogle Scholar
  60. Shah KK, Tarasova V, Davidian M, Anderson RJ. Painful acute radiation thyroiditis induced by 131I treatment of Graves’ disease. BMJ Case Rep. 2015. doi:10.1136/bcr-2014-207670.CrossRefPubMedPubMedCentralGoogle Scholar
  61. Stang MT, Yim JH, Challinor SM, Bahl S, Carty SE. Hyperthyroidism after parathyroid exploration. Surgery. 2005;138(6):1058–64.CrossRefPubMedGoogle Scholar
  62. Takasu N, Kamijo K, Sato Y, Yoshimura H, Nagata A, Ochi Y. Sensitive thyroid-stimulating antibody assay with high concentrations of polyethylene glycol for the diagnosis of Graves’ disease. Clin Exp Pharmacol Physiol. 2004;31(5–6):314–9.CrossRefPubMedGoogle Scholar
  63. Yamamoto M, Saito S, Sakurada T, Tamura M, Kudo Y, Yoshida K, Kaise K, Kaise N, Fukazawa H, Itagaki Y, et al. Recurrence of subacute thyroiditis over 10 years after the first attack in three cases. Endocrinol Jpn. 1988;35(6):833–9.CrossRefPubMedGoogle Scholar
  64. Zein EF, Karaa SE, Megarbane A. Familial occurrence of painful subacute thyroiditis associated with human leukocyte antigen-B35. Presse Med. 2007;36(5 Pt 1):808–9.CrossRefPubMedGoogle Scholar

Copyright information

© Crown 2018 2018

Authors and Affiliations

  1. 1.Department of Endocrinology and DiabetesSir Charles Gairdner HospitalNedlandsAustralia
  2. 2.School of Medicine and PharmacologyThe University of Western AustraliaCrawleyAustralia

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