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De Quervain's thyroiditis

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Title: De Quervain's thyroiditis  
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Subject: Subacute lymphocytic thyroiditis, Thyroid disease, Subacute thyroiditis, ICD-10 Chapter IV: Endocrine, nutritional and metabolic diseases, De Quervain
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De Quervain's thyroiditis

De Quervain's thyroiditis
Classification and external resources
Micrograph showing a granuloma in subacute thyroiditis. H&E stain.
ICD-10 E06.1
ICD-9 245.1
DiseasesDB 3474
MedlinePlus 000375
eMedicine med/534
MeSH D013968

de Quervain's thyroiditis, can also be known as subacute granulomatous thyroiditis or Giant Cell Thyroiditis. Males and females of all ages are affected. It is a member of the group of thyroiditis conditions known as resolving thyroiditis.

Contents

  • Terminology 1
  • Causes 2
  • Presentation 3
  • Treatment 4
  • Eponym 5
  • References 6

Terminology

It is sometimes called subacute thyroiditis,[1] but there are other forms of subacute thyroiditis, subacute lymphocytic thyroiditis, post partum thyroiditis, and autoimmune thyroiditis all of which, in contrast to DeQuervain's, are typically painless or "silent".

It is also sometimes called "painful subacute thyroiditis".[2] This is in contrast to subacute lymphocytic thyroiditis, which is also sometimes called "painless thyroiditis".

Causes

Some cases may be viral in origin, perhaps preceded by an upper respiratory tract infection. Viral causes include Coxsackie virus, mumps and adenoviruses. Some cases develop postpartum .

Presentation

Patients will experience a hyperthyroid period as the cellular lining of colloid spaces fails, allowing abundant colloid into the circulation, with neck pain and fever. Patients typically then become hypothyroid as the pituitary reduces TSH production and the inappropriately released colloid is depleted before resolving to euthyroid. The symptoms are those of hyperthyroidism and hypothyroidism. In addition, patients may suffer from painful dysphagia. There are multi-nucleated giant cells on histology. Thyroid antibodies can be present in some cases. The clinical presentation during the hyperthyroid phase can mimic those of Diffuse Toxic Goiter or Graves' disease. In such cases, a radionuclide thyroid uptake and scan can be helpful, since subacute thyroiditis will result in decreased isotope uptake, while Graves' disease will generally result in increased uptake. Distinguishing between these two types of disease is important, since Graves' disease and Diffuse Toxic Goiter can be treated with radioiodine therapy, but subacute thyroiditis is usually self-limited and is not treated with radioiodine.

Treatment

Treatment is beta blockers and NSAIDs (or corticosteroids if NSAIDs are ineffective).

Eponym

It is named for Fritz de Quervain.[3] It should not be confused with DeQuervain's syndrome.

References

  1. ^ Topuzovic N, Smoje J, Karner I (October 1997). "The therapeutic approach in subacute (de Quervain's) thyroiditis". J. Nucl. Med. 38 (10): 1665.  
  2. ^ Peter SA (October 1992). "Painful subacute thyroiditis (de Quervain's thyroiditis)". J Natl Med Assoc 84 (10): 877–9.  
  3. ^ synd/1139 at Who Named It?
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