Subacute de Quervain s Thyroiditis

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Subacute de Quervain s Thyroiditis

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1. Subacute (de Quervain’s) Thyroiditis Lauren Galpin, MD

4. Normal Thyroid

5. Thyrotoxicosis – Signs/Symptoms Nervousness Sweating Heat intolerance Palpitations Tachycardia Fatigue/weakness Weight loss Dyspnea Increased/decreased appetite Goiter Skin changes Tremor Atrial fibrillation Splenomegaly Gynecomastia Eye pain, diplopia, eye swelling, lid lag, proptosis

6. Thyrotoxicosis - differential Graves’disease Toxic adenoma (solitary) Toxic multinodular goiter Subacute thyroiditis Hashimoto’s thyroiditis (transient hyperthyroid phase) Thyrotoxicosis factitia Postpartum Struma ovarii Metastatic thyroid carcinoma Hydatidaform mole TSH-secreting pituitary tumor Pituitary resistance to triiodothryonine and thyroxine

7. Ahmed Thallage, Tariq Al-Zahrani: Anesthetic Management of Huge Goiter with Retrosternal Extension. The Internet Journal of Anesthesiology. 2005. Volume 10 Number 1.

8. Thyroiditis – Classification

9. Subacute thyroiditis - features 5:1 female predominance Age of onset 20-60y Prodrome (myalgias, fever, pharyngitis) Seasonal variation (?correlation with enterovirus?) Fever/severe neck pain 50-60% develop thyrotoxicosis 2-9% with recurrent disease Normal thyroid function returns in 95% 5% residual hypothyroidism Usually low to absent titer of anti-TPO immunoglobulins Thyroid storm – case reports

10. Diagnostic evaluation

11. Radioactive Iodine Uptake Scans

12. Subacute thyroiditis – pathology

13. Course of disease

14. Treatment Beta blockers – for symptomatic relief tachycardia/palpitations propranolol TPO inhibitors – contraindicated in absence of overproduction Methimazole PTU carbimazole Steroids – may be useful in reducing severe pain/fever, ?shorter course? NSAIDs – for mild pain control

15. Points to take home Subacute granulomatous thyroiditis is usually self-limited disease Hyper, normo, hypothyroid phases over course of 6-9 months Treat with propranolol, +/- steroids, NSAIDs Think of this diagnosis with patients who have FUO Hyperthyroid work-up should include TSH, free T4, RAIU at minimum

16. References Slatosky J, Shipton B, Wahba H. Thyroiditis: differential diagnosis and management. Am Fam Physician 2000 Jul 15;62(2):318. Pearce E, Farwell A, Braverman L. Current Concepts: Thyroiditis NEJM 2003; 348: 2646-55 Nishihara E, Ohye H, Amino N, Takata K, Arishima T, Kudo T, Ito M, Kubota S, Fukata S, Miyauchi A. Clinical characteristics of 852 patients with subacute thyroiditis before treatment. Kuma Hospital, Center for Excellence in Thyroid Care, Kobe. Intern Med. 2008;47(8):725-9. Epub 2008 Apr 16. Benbassat CA, Olchovsky D, Tsvetov G, Shimon I. Subacute thyroiditis: clinical characteristics and treatment outcome in fifty-six consecutive patients diagnosed between 1999 and 2005.Endocrine Institute, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel 49100. J Endocrinol Invest. 2007 Sep;30(8):631-5. Swinburne JL, Kreisman SH. A rare case of subacute thyroiditis causing thyroid storm. Thyroid. 2007 Jan;17(1):73-6.

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