Granulomatous thyroiditis (subacute thyroiditis, d

Granulomatous thyroiditis (subacute thyroiditis, de Quervain’s thyroiditis)

This may follow a viral infection. In a typical subacute presen tation, there is pain in the neck, fever, malaise and a firm, irregular enlargement of one or both thyroid lobes. There are tory markers, absent thyroid antibodies, the raised inflamma 123 is high normal or slightly raised and the I uptake serum T 4 of the gland is low . The condition is self-limiting and, in a few months, the goitre subsides and there may be a period of months of hypothyroidism before eventual recovery . In 10% of cases the onset is acute, the goitre is very painful and tender and there may be symptoms of hyperthyroidism. One-third of cases are asymptomatic but for the presence of diagnosis is in doubt, it may be confirmed by the goitre. If FNAC, radioactive iodine uptake and a rapid symptomatic response to prednisone. The specific treatment for the acute patient with severe pain is to give prednisone l0–20 /uni00A0 mg daily for 7 days and the dose is then gradually reduced over the next month. If thyroid failure is prominent, treatment with thyrox ine may be required until function recovers. This is very rare, accounting for 0.5% of goitres. Thyroid tissue is replaced by cellular fibrous tissue, which infiltrates through the capsule into muscles and adjacent structures, including parathyroids, recurrent nerves and the carotid sheath. It may occur in association with retroperitoneal and mediastinal fibrosis and is most probably a collagen disease. The goitre may be unilateral or bilateral and is very hard and fixed. The di ff er - ential diagnosis from anaplastic carcinoma can be made with certainty only by biopsy , when a wedge of the isthmus should also be removed to free the trachea. If unilateral, the other ypothyroidism lobe is usually involved later and subsequent h is common. Treatment is with high-dose steroids, tamoxifen and thyroxine replacement. Reduction in the size of the goitre and long-term improvement in symptoms are to be expected if treatment is commenced early .