Dr Zenonas Xydas
​MD, MBChB (Bristol), MRCP (London, UK), MRCEndo (London, UK), CCT (UK)
Thyroiditis
Summary
Viral Thyroiditis (known as De Quervain's Thyroiditis) is a DESTRUCTIVE disease of the thyroid due to a virus. The main symptom are pain of the neck, with the majority of patients experiencing a short period (6 weeks) of hyperthyroidism, followed by either normalisation of thyroid function (70% of cases) or permanent hypothyroidism (30% of cases)
General
De Quervain’s Thyroidis is a distinctive form of inflammation of the thyroid. Due to the inflammation of the thyroid, there is a painful enlargement of the thyroid gland which could be associated with fever or symptoms of overactive thyroid.
​
Females are affected three times more than the male population. The condition is usually triggered by a viral infection, examples of which include mumps, influenza, Coxsackie, adenovirus or ECHO.
Symptoms
The patient with thyroiditis could experience any of the following symptoms:
​
-
Due to inflammation of the thyroid
-
Painful neck, which is often sudden and could mimic a "sore throat" or "ear ache"
-
Typically, both lobes are enlarged
-
Pain during eating is common
-
​
-
Due to the alteration of the thyroid hormones
-
Fever or fluctuating temperature
-
Palpitations or awarness of the heart beating fast
-
Increased sweating
-
Transient alteration of periods (usually they become less frequent)
-
​
-
Symptoms due to the virus that has triggered the thyroiditis
-
Painful muscles
-
Painful joints
-
Tiredness
-
Generalized flu-like symptom
-
Diagnosis
There is no specific test that could be performed to diagnosed thyroiditis. The doctor may exclude other conditions that could cause similar symptoms. Therefore the diagnosis of thyroiditis is a clinical one. Sometimes a sepcial scan called Radioactive Iodine Uptake Scan may be required in cases where the diagnosis is unclear.
Progression
Characteristically, the condition progresses through a phase of an initial overactive thyroid (transient hyperthyroidism), which could often be followed 4-6 weeks later by a similar period of an underactive or low thyroid (transient hypothyroidism). The thyroid will usually return to normal activity 4-6 months after the onset of the illness.
Management
The condition is usually self-limiting, meaning that it will terminate by itself and the thyroid is expected to return to normal function in about 90% of cases. Therefore, management of the condition is directed towards the specific symptoms that the patient presents with:
​
-
Fever: Management with Paracetamol (Panadol) to symptomatically reduce fever
-
Neck pain due to thyroid inflammation: The pain experienced due to the inflammation of the thyroid, is often managed with Non-Steroidal Anti-Inflammatory (NSAIDs) drugs such as Ibuprofen, until the inflammation subsides. If NSAIDs are not sufficient for the pain, steroids may be needed for a short period.
-
Hyperthyroid Symptoms: If there are hyperthyroid symptoms (due to overactive thyroid), beta blockers (such as propranolol) may be used for symptomatic control of such symptoms.
-
Hypothyroid Symptoms: If thyroxine levels drop, a short course of thyroxine replacement might be required.