Refers to a transient patchy inflammation of the thyroid
De Quervain's thyroiditis
Describes the presentation of a viral infection with fever, neck pain and tenderness, dysphagia and features of hyperthyroidism
Aetiology
Ages 20-50
May be triggered by viral infection
Clinical presentation
Painful, diffuse, firm goitre
Fever and/or malaise may be present
There is a hyperthyroid phase followed by a hypothyroid phase as the TSH level falls due to negative feedback
Investigations
Thyroid function tests
May perform scintigraphy scan to rule out other causes of hyperthyroidism, will be low uptake throughout
FNAB → multinucleated giant cells
Management
Self-limiting condition - supportive treatment with NSAIDs for pain and inflammation and beta-blockers for symptomatic relief of hyperthyroidism is usually all that is necessary
Aspirin 600 mg/6-8 hr
Glucocorticoid → Prednisone 40-60 mg/day then tappering off in 6-8 weeks
If tyhrotoxicosis, give propanolol to relieve symptoms
If hypothyroid, give levothyroxine 50-100 mcg/day
Post-partum thyroiditis
See 'Thyroid Disease and Pregnancy' notes
Drug-induced thyroiditis
Aetiology
Drugs which can induce thyroiditis include amiodarone and lithium
Hypothyroidism occurs in 13% - tends to occur in iodine rich areas
Hyperthyroidism occurs in 2% - tends to occur in iodine deficient areas, split into type 1 (similar to Graves', type 2 (destructive thyroiditis) or mixed
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