Subacute thyroiditis

Subacute (de Quervain) thyroiditis is an inflammation of the thyroid that results in transient thyrotoxicosis (due to release of preformed thyroid hormone from damaged thyroid follicles), followed by hypothyroidism, and usually a subsequent return to euthyroidism. It should be suspected when pain in the thyroid area, often radiating to the ears or jaw, is associated with fever, malaise and variable symptoms of thyrotoxicosis (early) or hypothyroidism (late).

Erythrocyte sedimentation rate is markedly elevated, and nuclear thyroid scan shows near absent uptake.

If pain and constitutional symptoms are mild, the only therapy required may be temporary beta blockade to relieve symptoms during the thyrotoxic stage—see Beta blockers for symptoms of thyrotoxicosis.

For initial treatment of painful thyroiditis, use:

In severe or persistent cases, prednisolone (or prednisone) is effective for relieving pain and reducing inflammation. Use:

Antithyroid drugs are not effective during the thyrotoxic stage and have no place in treatment. If the hypothyroid stage is persistent or symptomatic, thyroxine replacement may be required.