De Quervain thyroiditis, or subacute granulomatous thyroiditis, is a self-limiting subacute thyroiditis usually preceded by an upper respiratory tract viral infection.
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Epidemiology
De Quervain thyroiditis most commonly affects 30 to 60-year-old females (F:M = 5:1), with an increased incidence in summer and autumn 5,6.
Diagnosis
De Quervain thyroiditis is a clinical diagnosis based on history, laboratory results, and imaging findings 5,6. FNA is not routinely recommended 6.
Clinical presentation
Many patients (~45%, range 40-50% 5) present with a painful neck along with symptoms and signs of thyrotoxicosis, including tachycardia, hot flushes, heat intolerance and palpitations 6. Subsequently, painless hypothyroidism ensues for up to 6 months, followed by a return to a euthyroid state in most (~90%) patients 5,6.
Pathology
A viral infection (e.g. mumps, measles, coxsackie virus, adenovirus, Epstein-Barr virus, SARS-CoV-2 virus, influenza virus) typically precedes De Quervain thyroiditis 5,6. The viral antigen binds to HLA-B35 and activates cytotoxic T-cells, damaging thyroid follicular cells and releasing T3 and T4 thyroid hormones 5.
Markers
elevated inflammatory markers, e.g. CRP, ESR (>50) 5,6
T3/T4: high 5,6
TSH: low 5,6
thyroid autoantibodies (e.g. anti-TPO, anti-thyroglobulin): may be high 5
Radiographic features
Ultrasound
The most commonly described sonographic appearance is poorly defined regions of decreased echogenicity with decreased vascularity in the affected areas 1. These can be bilateral or unilateral. The thyroid gland size is mostly normal but can occasionally be enlarged or smaller in size 2.
Nuclear medicine
Low uptake on a thyroid scan in patients with hyperthyroidism is almost diagnostic, in appropriate clinical setting and ultrasound findings 6. Correct diagnosis is important as treatment with radioiodine is contraindicated in these patients - it is a self-limiting disease.
Treatment and prognosis
De Quervain thyroiditis is usually self-limiting with supportive treatment of pain and thyrotoxicosis symptoms 3-6.
History and etymology
It is named after Fritz de Quervain (1868-1940), a Swiss surgeon.
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