Inflammation of the thyroid gland is called thyroiditis. Thyroiditis is a condition classified by the way they affect thyroid functions or whether they are painful. Thyroiditis types can be determined by evaluating the patient’s symptoms, changes in thyroid functions, presence of familial history, rapid or slow progression of the picture, presence of pain in the neck or whether there is an enlargement of the thyroid gland.
De Quervain’s thyroiditis is in the class of painful thyroiditis. Other names are subacute thyroiditis, subacute nonsuppurative thyroiditis, giant cell thyroiditis and subacute granulomatous thyroiditis.
De Quervain’s thyroiditis is a subacute inflammatory disease of the thyroid gland that usually develops 2-8 weeks after viral upper respiratory tract infections. Mumps, coxsackie, echovirus, measles, influenza, SARS-CoV-2 and adenoviruses are blamed.
De Quervain’s thyroiditis is the most common cause of thyroid-related neck pain. Moderate thyroid enlargement and inflammatory reaction including thyroid capsule are seen. It is more common in summer and in women.
In patients with De Quervain’s thyroiditis, high levels of T3 and T4 thyroid hormones are released, causing damage to the typhoid follicles. While clinical signs of hyperthyroidism develop, TSH hormone is also suppressed. However, this takes 2-8 weeks. Because due to inflammation, the release of thyroid hormones in the thyroid stores ends and the newly produced hormones can only be released. Afterwards, thyroid hormones return to normal levels and even begin to fall. Because of thyroiditis, the cells that are supposed to produce thyroid have also been damaged and the production of new hormones has slowed down.
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Symptoms in De Quervain’s thyroiditis:
These patients present with fever, malaise, unilateral or bilateral neck pain under the jaw, and pain that may radiate towards the ear. In addition, palpitations, irritability and sweating due to hyperthyroidism may also be seen. There are no ocular symptoms in hyperthyroidism due to De Quervain’s thyroiditis. The thyroid gland is sensitive and the patient does not want to touch his neck.
Diagnosis of De Quervain’s thyroiditis:
In these patients, excessively high thyroid hormones are noteworthy in the initial period. TSH is low. The sedimentation rate has increased. Inflammation and microabscesses are seen in the thyroid tissue. Granulomatous appearance occurs due to inflammation. The classic honeycomb image of the thyroid follicles is distorted. Inflammation tests such as CRP may also be high in the patient.
The most common symptom is pain in the patient’s neck that increases with movement. Even coughing or swallowing can increase the pain. During the period of hyperthyroidism, symptoms such as tachycardia and palpitations may also be seen in the patient. There is a patient profile who frequently presents with fever of unknown origin.
Thyroid hormone levels are extremely high for the first 2-8 weeks. He has hyperthyroidism. During this period, liver function tests may also be abnormal. This situation is temporary. Over time, thyroid hormones normalize and even begin to fall. TSH levels begin to rise during the period of hypothyroidism, when thyroid hormones begin to decline. While the radioactive iodine uptake test is low in the initial phase, radioactive iodine uptake begins to increase with the decrease in thyroid hormones in the following period. In addition, thyroglobulin levels in the blood are high in De Quervain’s thyroiditis, while thyroid autoantibodies are negative.
In De Quervain’s thyroiditis, thyroid ultrasonography and color Doppler imaging can show a decreased and then normal blood supply during the hyperthyroid period. There is a slightly enlarged thyroid.
De Quearvain’s thyroiditis is a condition that should be differentiated from lymphoma, thyroid cancers and other causes of thyroid bleeding. If the patient also has leukocytosis, acute infectious thyroiditis should also be considered.
Treatment of De Quervain’s thyroiditis:
Treatment of De Quervain’s thyroiditis is usually symptomatic. Anti-inflammatory therapy is given. Acetylsalicylic acid, naproxen or ibuprofen can be used. In advanced cases, prednisone may also be required. With anti-inflammatory treatment, the pain goes away in 2-3 days. Sometimes attacks of pain may occur. Steroid support may be required from time to time. In cases where the pain does not improve, other causes of painful thyroiditis are investigated. If the patient is pregnant, an evaluation of the obstetrics clinic should be done.
In some cases, symptoms may begin to appear again while the disease is expected to resolve. This may be due to one of the thyroid lobes being later affected. Years later, the picture may repeat. 90% of cases heal without inflicting damage. Hypothyroidism may develop in 10% and permanent hypothyroidism in 5%. In these patients, lifelong T4 hormone support may be required.