Subacute Thyroiditis
Update (April 2008): The article below was written in September 2006. Professor Farid reports that, in 2008, he has yet to see a single case of sub-acute thyroiditis, emphasising that the environmental conditions conducive to the epidemic in 2006 no longer exist.
Prof. Farid has seen several patients with Subacute thyroiditis in recent weeks. He speculates that we have seen this cluster of cases because of the very hot summer that simulated the climatic conditions around the great lakes.
Interestingly, his wife was the latest victim of this troubling disease. She was not diagnosed until over four weeks after her first symptoms, having seen her GP a couple of times. After much debate, subacute thyroiditis was eventually identified. He also has twin grandchildren who were diagnosed with the same condition. One woman flew in from Spain to see him after she was diagnosed with thyroid cancer there and he was able to reassure her that she did not need cancer treatment or to have her thyroid gland removed but instead has subacute thyroiditis. Another patient was the son of a doctor, so it appears that doctors are finding it hard to diagnose too.
Definition
Subacute thyroiditis, sometimes referred to as granulomatous or De Quervain's thyroiditis, is a spontaneously remitting inflammatory condition of the thyroid gland that may last for weeks to several months. It was first described in 1904. The condition often occurs after a viral infection of the upper respiratory tract. Mumps virus, influenza virus, and other respiratory viruses have been found to cause subacute thyroiditis. There have been many cases reported in Japan and North America. Subacute thyroiditis occurs most often in middle-aged women with recent symptoms of viral respiratory tract infection. The prevalent month is July.
Clinical Manifestations
The thyroid gland generally swells rapidly and is very painful and tender. The gland discharges thyroid hormone into the blood and the patients become hyperthyroid (pain in the region of the thyroid gland as the most prominent feature); however the gland quits taking up iodine (radioactive iodine uptake is very low) and the hyperthyroidism generally resolves over the next several weeks. The patients frequently become ill with fever and must go to bed. Hoarseness or difficulty swallowing may also develop.
Thyroid antibodies are not present in the blood, but the sedimentation rate, which measures inflammation, is very high.
Symptoms of thyroid hormone excess (hyperthyroidism) such as nervousness, rapid heart rate, and heat intolerance may be present early in the disease. Later, symptoms of too little thyroid hormone (hypothyroidism) such as fatigue, constipation, or cold intolerance may occur.
Treatment
For a mild disease, symptomatic relief is achieved with anti-inflammatory drugs.
For a more serious disease, steroid is the option of choice for a two week period.
Beta blockers are also administered to minimise the symptoms of inflammation.
Following Thyroiditis
Nearly all patients recover and the thyroid gland returns to normal after several weeks or months. A few patients become hypothyroid and need to stay on thyroid hormone replacement indefinitely. Recurrences are uncommon.
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