De quervain s thyroiditis pathophysiology. Master Subacute Granulomatous Thyroiditis (de Quervain) with Picmonic for Medicine
Cases of autoimmune thyroid disease 1 and subacute thyroiditis 2—4 associated with SARS-CoV-2 infection have been reported.
A year-old woman with no personal or family history of interest and no ongoing treatment was seen at an endocrinology clinic due de quervain s thyroiditis pathophysiology pain in the thyroid area for the previous two months.
The pain, which worsened with swallowing and neck movements, started in the right thyroid area, radiated to the right ear and, a month later, spread to the left thyroid lobe and left ear.
This was accompanied by a low-grade fever, malaise and insomnia. She had no signs or symptoms of thyrotoxicosis.
Examination revealed a grade 1 goitre with significant pain on palpation. The patient provided the results of laboratory testing ordered by her general practitioner that showed hyperthyroidism, with thyroid-stimulating hormone TSH levels of 0.
Subacute Thyroiditis (Thyroid Inflammation; De Quervain’s) - Causes, Symptoms, Diagnosis, Treatment
She had started treatment with non-steroidal anti-inflammatory drugs NSAIDs with partial improvement in her symptoms. As subacute thyroiditis was suspected, oral prednisone 40 mg per day on a down-titration regimen for six weeks and further hormone testing with autoimmunity, thyroid ultrasound and thyroid scintigraphy were ordered.
Last updated: April 27, Summary Subacute thyroiditis refers to a transient patchy inflammation of the thyroid gland that is associated either with granuloma formation subacute granulomatous thyroiditis or lymphocytic infiltration subacute lymphocytic thyroiditis. While subacute granulomatous thyroiditis usually occurs after a viral upper respiratory tract infectionsubacute lymphocytic thyroiditis occurs either during the postpartum periodin association with other autoimmune diseases, or as a side effect of certain drugs. Both forms of subacute thyroiditis are more common among women and are characterized by a triphasic clinical course that classically transitions from hyperthyroidism to hypothyroidismbefore returning to a euthyroid phase.
Two weeks later, the patient showed significant clinical improvement in her thyroid function TSH levels of 0. Neck ultrasound revealed a heterogeneous enlarged thyroid gland with normal vascularisation and a heterogeneous, hypoechogenic left thyroid nodule measuring 15 mm × 30 mm, with no cervical lymphadenopathy.
Thyroid scintigraphy showed overall hypouptake of the radioactive tracer, consistent with the clinical suspicion of thyroiditis. At her monthly check-up, the patient showed resolution of her signs and symptoms.
Key Points Subacute thyroiditis is an acute inflammatory disease of the thyroid probably caused by a virus. Symptoms include fever and thyroid tenderness. Initial hyperthyroidism is common, sometimes followed by a transient period of hypothyroidism.
Laboratory testing revealed mild thyroid hypofunction TSH 7. The FNAB was insufficient for diagnosis.
Another FNAB was ordered, but a follow-up ultrasound did not show any thyroid nodule; it only showed areas of focal hypoechogenicity, with no nodules that could be delimited. The patient's thyroid function returned to normal within three months. It has been most often linked to enterovirus, adenovirus, Coxsackievirus and measles virus infections as well as parathyroiditis.
Additional testing and her clinical course supported the diagnosis of subacute thyroiditis, and serology confirmed past COVID; active infection was ruled out on two occasions in the course of her clinical follow-up. Hence, given the non-negligible percentage of patients who do not show symptoms, we believe that patients with signs and symptoms consistent with subacute thyroiditis must be assessed for possible past COVID References M. Mateu-Salat, E. Urgell, A. J Endocrinol Invest, 43pp.
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