DE QUERVAIN'S THYROIDITIS or sub-acute thyroiditis: causes, symptoms, diagnosis and therapy

There thyroiditis it is an inflammatory process affecting the gland thyroid. There De Quervain's thyroiditis, or subacute thyroiditis, is a pathology with probable viral genesis, characterized by temperature, ache is swelling in the neck at the thyroid gland. It is characterized by an initial hyperthyroidism, followed by a transient hypothyroidism, with a return to normal thyroid function in most cases.

What is De Quervain's thyroiditis?

There thyroiditis subacuta or De Quervain, also called granulomatous thyroiditis, migrating thyroiditis or painful subacute thyroiditis, is an inflammation of the thyroid gland characterized clinically by a rapid onset associated with fever, general asthenia and severe pain in the thyroid gland, often with swelling at the thyroid gland. Sometimes we observe a phenomenon completely characteristic of this type of thyroiditis: the migration of the painful swelling in different points of the thyroid gland: hence the name of migrating thyroiditis.De Quervain's thyroiditis is not a rare disease, it mainly affects women (the female sex is 4 times more likely to contract this pathology than men), and occurs in individuals of all ages, even if the most affected range is from 30 to 50 years.

Causes of De Quervain's Thyroiditis

The causes precise that involve the development of sub-acute thyroiditis they are not fully identified. The triggering event that precedes the onset of thyroiditis is believed to be a viral infection:viral etiology it is supported on the basis of clinical, epidemiological data and the detection of high titers of antiviral antibodies during the course of the disease; titers that tend to decrease during the remission phases. The viruses most frequently identified are enterovirus, mumps virus, coxsackie viruses, adenoviruses, influenza viruses, measles, Epstein Barr Virus (EBV) and many others. Another factor confirming this hypothesis is the fact that the disease appears in 50% of cases after an upper respiratory infection. A particular feature of this disease is that the inflammation affecting the thyroid gland can migrate from one lobe to another.

De Quervain's Thyroiditis Symptoms

There thyroiditis subacuta of De Quervain is characterized by an initial phase of hyperthyroidism, linked to the release of a large amount of thyroid hormones in the circulation, followed by a phase of thyroid hypofunction, with hypothyroidism more or less marked. Finally, there is normally a return to normal thyroid function (euthyroidism).Symptoms of De Quervain's thyroiditis so I am:

    • intense pain, sometimes also radiating to the jaw, ear and neck
    • fever (even> 39 ° C)
    • swelling (swelling) of the neck at the thyroid gland
    • laterocervical lymphadenopathy (enlarged lymph nodes in the neck)
    • myalgia (muscle pain)
    • arthralgia (joint pain)
    • headache (headache)
    • nausea and / or vomiting
    • decrease in body weight

Furthermore, in the initial phase, symptoms of thyrotoxicosis are observed due to the release of thyroid hormones into the circulation by the damaged thyroid follicles. During the first days i symptoms of De Quervain's thyroiditis linked to thyrotoxicosis will therefore be:

    • irritability
    • diarrhea
    • tachycardia
    • nervousness and irritability
    • sweating

The phase thyrotoxic it usually lasts a few weeks, and is present in over half of affected patientsAfter the hyperthyroid phase, the disease begins with a phase of euthyroidism, followed by a phase of 2-4 months of transient hypothyroidism and then by a functional recovery.In the period characterized by hypothyroidism the symptoms of thyrotoxicosis will disappear and symptoms such as:

    • asthenia (tiredness)
    • weight gain
    • constipation
    • menstrual irregularities in women
    • bradycardia (slow heart rate)
    • reduced tolerance to cold

Duration of De Quervain's thyroiditis

How long does de Quervain's subacute thyroiditis last? Typically the pathology has one duration of 3-6 months although in some cases it can persist, with periods of remissions and relapses, even for 12-18 months. The frequent relapses of this pathology justify the name of thyroiditis relapsing.

De Quervain's Thyroiditis Diagnosis

How is the diagnosis of subacute thyroiditis? Diagnosis is made based on clinical and laboratory data. The endocrinologist specialist or in any case the doctor who will evaluate the patient will carry out an accurate medical history (complete clinical history of the patient) and a thorough physical examination, and not only isolated to the thyroid region.As regards the blood analysis, during this inflammatory pathology there is a very high increase in C reactive protein and ESR, with an increase in white blood cells (leukocytosis) and in particular in lymphocytes (lymphocytosis). In the initial phase there will be an increase in the concentrations of thyroid hormones FT3 ed FT4 and thyroglobulin, parallel to a TSH low or suppressed. In the second phase we will have a reduction of free thyroxin and free triiodothyronine and an increase in thyrotropin.L'thyroid ultrasound will usually show hypoechoic areas, which vary during the evolution of the disease. The uptake of radioactive iodine during subacute thyroiditis is usually very poor due to the destruction of the thyroid follicular cells. Among the second level biohumoral investigations, the ratio T4 / T3 is carried out (which is unbalanced in favor of T4 and therefore high), antibodies to thyroglobulin (anti-Tg), anti thyroid thyroid peroxidase (anti-TPO) and anti TSH receptor (anti-TSH-R), which are initially absent or with a low titer while as thyroiditis progresses they may be present, even at high levels antibodies.

De Quervain's Thyroiditis Treatment

How subacute thyroiditis is treated? Therapy varies according to the stage of the thyroiditis. Since the disease is self-limiting, it is often sufficient to treat only the associated symptoms, thus using antipyretics (paracetamol) or anti-inflammatory (NSAIDs such as ketoprofen, ibuprofen, diclofenac, better known by the trade names of Oki, Moment, Brufen, Voltaren). In the most important cases, in which the pain is particularly intense, it is necessary to administer cortisone, such as prednisone (Deltacortene), at the initial dose of 50-75 mg per day for the first few weeks, and then gradually tapering the dose from 3rd-4th week onwards. As for the control of symptoms related to thyroid dysfunction, in the phase of thyrotoxicosis in which there is hyperthyroidism, it is possible to use a beta-blocker drug, such as propanolol or atenololIn case of evolution of thyroiditis towards permanent hypothyroidism it is administered thyroid replacement therapy with levothyroxine (L-T4, more common trade names Eutirox or Tirosint), in the same way followed for primary hypothyroidism (therefore starting from a dosage of 1.2-1.5 pg per kg of body weight per day), checking thyroid hormones and TSH after 1-2 weeks and adjusting the therapy.

De Quervain's Thyroiditis Prognosis

There prognosis of this pathological condition is very good, with over 90% of patients achieving spontaneous resolution of the disease within 6 months of onset. Only in 10% of cases, the thyroid does not return to function exactly as before, which is why in this small percentage of patients it is necessary to institute replacement therapy for permanent hypothyroidism.


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