Recurrences and hypothyroidism are rare
after recovery in subacute granulomatous thyroiditis
(July 2003)
The background of the study. Subacute
granulomatous thyroiditis (de Quervain's thyroiditis) is characterized
by thyroid pain and tenderness, symptoms of inflammation, and transient
hyperthyroidism and hypothyroidism. This study was done to determine
the characteristics and outcome of this disorder.
How the study was done. Cases of
subacute granulomatous thyroiditis (hereafter referred to as subacute
thyroiditis) were identified from the records of residents of Olmsted
County, Minnesota. The inclusion criteria were thyroid pain and
a low thyroid radioiodine uptake or high erythrocyte sedimentation
rate, or a pathological diagnosis of the disorder. The records were
reviewed through 1997, and interviews were conducted if no recent
information was available.
The results of the study. There
were 160 cases of subacute thyroiditis between 1960 and 1997. The
clinical findings were evaluated in the 94 cases seen between 1970
and 1997; 73 were women and 21 were men (average age, 46 years).
The findings were: upper respiratory infection before thyroiditis,
20 patients (21 percent); thyroid pain, 91 patients (97 percent);
difficulty swallowing, 30 patients (32 percent); and thyroid tenderness,
89 patients (95 percent). The thyroid gland was normal in size in
19 patients and enlarged in 57 patients. Many patients had high
serum free thyroxine and low serum thyrotropin (TSH) concentrations,
and nearly all patients had a low thyroid radioiodine uptake and
a high erythrocyte sedimentation rate. The patients were treated
with prednisone, a nonsteroidal anti-inflammatory drug, or both,
or acetaminophen. The mean time to resolution of thyroid pain was
four days in the patients treated with prednisone and 35 days in
those treated with a nonsteroidal anti-inflammatory drug.
Nine patients (10 percent) had a recurrence of symptomatic thyroiditis
within 6 to 12 months, and 4 patients (4 percent) had a recurrence
6 to 21 years later. Twenty-seven patients (29 percent) had a high
serum TSH concentration in the first year after diagnosis; 9 were
being treated with thyroxine at last follow-up. Hypothyroidism occurred
2 to 24 years later in 5 patients (5 percent).
The conclusions of the study. Late
recurrence and permanent hypothyroidism are rare in patients with
subacute thyroiditis.
The original article. Fatourechi
V, Aniszewski JP, Fatourechi GZ, Atkinson EJ, Jacobsen SJ. Clinical
features and outcome of subacute thyroiditis in an incidence cohort:
Olmsted County, Minnesota, study. J Clin Endocrinol Metab 2003;88:2100-5.
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