Dr Zenonas Xydas

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.

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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.

The patient with thyroiditis could experience any of the following symptoms:

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• 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

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• 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)

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• Symptoms due to the virus that has triggered the thyroiditis

  • Painful muscles

  • Painful joints

  • Tiredness

  • Generalized flu-like symptom

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.

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.

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:

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• 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.