SUBACUTE THYROIDITIS

Janseen M. Ediza BSN III

Subacute thyroiditis involves swelling (inflammation) of the thyroid gland that usually follows an upper respiratory
infection.
Subacute thyroiditis is a self-limited thyroid condition associated with a triphasic clinical course of
hyperthyroidism, hypothyroidism, and return to normal thyroid function. Subacute thyroiditis may be responsible
for 15-20% of patients presenting withthyrotoxicosis and 10% of patients presenting with hypothyroidism.
Recognizing this condition is important; because it is self-limiting, no specific treatment, such as antithyroid or
thyroid hormone replacement therapy, is necessary in most patients. (See Presentation, Workup, and Treatment.)
In general, the following 3 forms of subacute thyroiditis are recognized:
Subacute granulomatous thyroiditis - Also known as subacute painful or de Quervain thyroiditis
Lymphocytic thyroiditis - Also known as subacute painless thyroiditis
Subacute postpartum thyroiditis

Subacute thyroiditis is a rare condition. It is thought to be caused by a viral infection. The condition often occurs
after a viral infection of the upper respiratory tract, such as mumps and influenza.
Subacute thyroiditis occurs most often in middle-aged women with recent symptoms of a viral respiratory tract
infection.
The most obvious symptom of subacute thyroiditis is pain in the neck. Sometimes the pain can spread (radiate) to
the jaw or ears. Painful enlargement of the thyroid gland may last for weeks or months.
Other symptoms include:
Difficulty swallowing
Fatigue
Fever
Hoarseness
Tenderness when gentle pressure is applied to the thyroid gland (palpation)
Weakness
Symptoms of too much thyroid hormone (hyperthyroidism) may include:
Diarrhea
Heat intolerance
Nervousness
Palpitations
Sweating
Tremor
Weight loss
Later, symptoms of too little thyroid hormone (hypothyroidism) may occur, including:
Cold intolerance
Constipation
Fatigue
Usually thyroid gland function returns to normal. But in some cases hypothyroidism may be permanent.

Acute complications
When acute complications do occur, they can include the following:
Severe hyperthyroidism - May be observed during the inflammatory phase
Multiple system organ failure - May complicate the course of the disease in exceptionally rare cases
Pancreatitis or splenomegaly - Associated with de Quervain thyroiditis in case reports only
Vocal cord paralysis - Occurs occasionally in cases with severe thyroid gland inflammation
Cerebral venous thrombosis - has been reported in some cases; in one case, the patient was a heterozygous carrier
for the G20210A mutation of the prothrombin gene, which predisposed her to this complication
Long-term complications
Permanent hypothyroidism is the most frequent long-term complication of de Quervain thyroiditis. It is observed in
less than 5-10% of the patients and requires thyroid replacement therapy.
Disease recurrence has been documented in occasional cases (up to 20% of cases in some series). Recurrence is
more frequent in the first year but has been reported even 30 years after the initial diagnosis. The risk of recurrence
cannot be correlated with initial thyroid function, inflammatory syndrome, or ultrasonographic aspect (ie, thyroid
volume, echogenicity).
Laboratory tests early in the course of the disease may show:
Low serum thyroid stimulating hormone (TSH) level
High serum free T4 (thyroid hormone, thyroxine) level
Low radioactive iodine uptake
High serum thyroglobulin level
High erythrocyte sedimentation rate (ESR)
Laboratory tests later in the disease may show:
High serum TSH level
Low serum free T4
There may be low levels of antithyroid antibodies. Thyroid gland biopsy is usually not needed, but will show a
type of inflammation characteristic of this condition. Lab tests should return to normal as the condition goes away.
The purpose of treatment is to reduce pain and inflammation and treat hyperthyroidism, if it occurs. Anti-
inflammatory medications such as aspirin or ibuprofen are used to control pain in mild cases.
More serious cases may need temporary treatment with steroids (for example, prednisone) to control inflammation.
Symptoms of hyperthyroidism are treated with a class of medications called beta blockers (for example,
propranolol, atenolol). Antithyroid drugs or thionamides are not effective in treating this condition.
Hyperthyroidism
Provide a cool and quiet environment.
Provide a high-calorie diet.
Pain relievers per doctors order
Hypothyroidism
Provide a warm environment for the client.
Monitor vital signs, including heart rate and rhythm.
Instruct the client in low-calorie, low-cholesterol, low-saturated-fate diet.
More common to middle-aged women (5:1)
The condition should improve on its own. However, the illness may last for months. Long-term or severe
complications do not usually occur.

Destruction of follicular epithelium and loss of follicular integrity are the primary events in the pathophysiology of
subacute granulomatous thyroiditis. Thyroglobulin (TG), thyroid hormones, and other iodinated compounds are
released into the blood, often in quantities sufficient to elevate the serum thyroxine (T4) and triiodothyronine (T3)
concentrations and suppress thyroid-stimulating hormone (TSH) secretion. This state lasts until the stores of TG
are exhausted or until healing occurs. Thyroidal iodine uptake and new hormone synthesis temporarily ceases
because of the low level of TSH.
As inflammation subsides, the thyroid follicles regenerate and thyroid hormone synthesis and secretion resume. In
some patients, several months are required for thyroid hormone synthesis to return to a normal rate; during that
period, clinical hypothyroidism may be evident.