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1. Subacute (de Quervain’s) Thyroiditis Lauren Galpin, MD
4. Normal Thyroid
5. Thyrotoxicosis – Signs/Symptoms Nervousness
Eye pain, diplopia, eye swelling, lid lag, proptosis
6. Thyrotoxicosis - differential Graves’disease
Toxic adenoma (solitary)
Toxic multinodular goiter
Hashimoto’s thyroiditis (transient hyperthyroid phase)
Metastatic thyroid carcinoma
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
TPO inhibitors – contraindicated in absence of overproduction
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. [email protected] 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. [email protected] 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.