Skip to main content
SpringerLink
Log in

Acute and Subacute Thyroiditis

  • Living reference work entry
  • First Online:
Thyroid Diseases

Part of the book series: Endocrinology ((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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Al-Dajani N, Wootton SH. Cervical lymphadenitis, suppurative parotitis, thyroiditis, and infected cysts. Infect Dis Clin North Am. 2007;21(2):523–41, viii.

    Article  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Assir MZ, Jawa A, Ahmed HI. Expanded dengue syndrome: subacute thyroiditis and intracerebral hemorrhage. BMC Infect Dis. 2012;12:240.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Bennedbaek FN, Hegedus L. The value of ultrasonography in the diagnosis and follow-up of subacute thyroiditis. Thyroid. 1997;7(1):45–50.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Carney JA, Moore SB, Northcutt RC, Woolner LB, Stillwell GK. Palpation thyroiditis (multifocal granulomatour folliculitis). Am J Clin Pathol. 1975;64(5):639–47.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Desailloud R, Hober D. Viruses and thyroiditis: an update. Virol J. 2009;6:5.

    Article  PubMed  PubMed Central  Google Scholar 

  • Engkakul P, Mahachoklertwattana P, Poomthavorn P. Eponym: de Quervain thyroiditis. Eur J Pediatr. 2011;170(4):427–31.

    Article  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Espiritu RP, Dean DS. Parathyroidectomy-induced thyroiditis. Endocr Pract. 2010;16(4):656–9.

    Article  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Goldani LZ, Zavascki AP, Maia AL. Fungal thyroiditis: an overview. Mycopathologia. 2006;161(3):129–39.

    Article  PubMed  Google Scholar 

  • Hamaguchi E, Nishimura Y, Kaneko S, Takamura T. Subacute thyroiditis developed in identical twins two years apart. Endocr J. 2005;52(5):559–62.

    Article  PubMed  Google Scholar 

  • Hendrick JW. Diagnosis and management of thyroiditis. J Am Med Assoc. 1957;164(2):127–33.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Kitchener MI, Chapman IM. Subacute thyroiditis: a review of 105 cases. Clin Nucl Med. 1989;14(6):439–42.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Kramer AB, Roozendaal C, Dullaart RP. Familial occurrence of subacute thyroiditis associated with human leukocyte antigen-B35. Thyroid. 2004;14(7):544–7.

    Article  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Mai VQ, Glister BC, Clyde PW, Shakir KM. Palpation thyroiditis causing new-onset atrial fibrillation. Thyroid. 2008;18(5):571–3.

    Article  PubMed  Google Scholar 

  • Majid U, Islam N. Thyroid tuberculosis: a case series and a review of the literature. J Thyroid Res. 2011;2011:359864.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • Miyauchi A. Thyroid gland: a new management algorithm for acute suppurative thyroiditis? Nat Rev Endocrinol. 2010;6(8):424–6.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Mygind H. Thyroiditis akuta simplex. J Laryngol Rhinol Otol. 1895;9:181–93.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Nishiyama K, Kozuka T, Higashihara T, Miyauchi K, Okagawa K. Acute radiation thyroiditis. Int J Radiat Oncol Biol Phys. 1996;36(5):1221–4.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Rosenstein ED, Kramer N. Occult subacute thyroiditis mimicking classic giant cell arteritis. Arthritis Rheum. 1994;37(11):1618–20.

    Article  CAS  PubMed  Google Scholar 

  • Ross DS. Radioiodine therapy for hyperthyroidism. N Engl J Med. 2011;364(6):542–50.

    Article  CAS  PubMed  Google Scholar 

  • Samuels MH. Subacute, silent, and postpartum thyroiditis. Med Clin North Am. 2012;96(2):223–33.

    Article  CAS  PubMed  Google Scholar 

  • Schofield PM, Keal EE. Subacute thyroiditis associated with Chlamydia psittaci infection. Postgrad Med J. 1986;62(723):33–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • Stang MT, Yim JH, Challinor SM, Bahl S, Carty SE. Hyperthyroidism after parathyroid exploration. Surgery. 2005;138(6):1058–64.

    Article  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  CAS  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, 6009, Australia

    Karen M. Rothacker & John P. Walsh

  2. School of Medicine and Pharmacology, The University of Western Australia, Crawley, WA, 6009, Australia

    John P. Walsh

Authors
  1. Karen M. Rothacker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John P. Walsh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John P. Walsh .

Editor information

Editors and Affiliations

  1. Department of Endocrinology, University of Pisa, Pisa, Italy

    Paolo Vitti

  2. Department of Endocrinology and Metaboli, Odense Univeristy Hospital, Odense, Denmark

    Laszlo Hegedus

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Her Majesty the Queen in Right of Australia

About this entry

Cite this entry

Rothacker, K.M., Walsh, J.P. (2016). Acute and Subacute Thyroiditis. In: Vitti, P., Hegedus, L. (eds) Thyroid Diseases. Endocrinology. Springer, Cham. https://doi.org/10.1007/978-3-319-29195-6_9-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-29195-6_9-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Online ISBN: 978-3-319-29195-6

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation