Thyroiditis de Quervain

SummaryBackground: Subacute thyroiditis is a usually self-limiting disease of the thyroid. However, approximately 0.5–15% of the patients require permanent thyroxine substitution. Aim was to determine predictive factors for the necessity of long-term hormone-replacement (LTH). Patients, methods: We retrospectively reviewed the records of 72 patients with subacute thyroiditis. Morphological and serological parameters as well as type of therapy were tested as predictive factors of consecutive hypothyroidism. Results: Mean age was 49 ± 11 years, f/m-ratio was 4.5 : 1. Thyroid pain and signs of hyperthyroidism were leading symptoms. Initial subclinical or overt hyperthyroidism was found in 20% and 37%, respectively. Within six months after onset 15% and 1.3% of the patients developed subclinical or overt hypothyroidism, respectively. At latest follow-up 26% were classified as liable to LTH. At onset the thyroid was enlarged in 64%, and at latest follow-up in 8.3%, with a significant reduction of the thyroid volume after three months. At the endpoint the thyroid volume was less in patients in the LTH group compared with the non-LTH group (41.7% vs. 57.2% of sex-adjusted upper norm, p = 0.041). Characteristic ultrasonographic features occurred in 74% of the patients in both lobes. Serological and morphological parameters as well as type of therapy were not related with the need of LTH. Conclusions: In this study the proportion of patients who received LTH was 26%. At the endpoint these patients had a lower thyroid volume compared with euthyroid patients. No predictive factors for LTH were found.

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The sonographical and functional sequelae of de Quervain's subacute thyroiditis: long-term follow-up

Acta Endocrinologica ◽

10.1530/acta.0.1170435 ◽

1988 ◽

Vol 117 (4) ◽

pp. 435-441 ◽

Cited By ~ 20

Author(s):

G. Benker ◽

Th. Olbricht ◽

R. Windeck ◽

R. Wagner ◽

H. Albers ◽

...

Keyword(s):

Thyroid Volume ◽

Acute Stage ◽

Subacute Thyroiditis ◽

Serum Thyroglobulin ◽

Ultrasound Findings ◽

Close Observation ◽

Long Term Follow Up ◽

Normal Ultrasound

Abstract. Fifty-three patients with subacute thyroiditis (SAT) were seen during the acute stage of the disease. HLA-Bw 35 was positive in 33 out of 39 tested patients. At first presentation, all examined patients (N = 23) had ultrasound abnormalities (generalized hypodensity, single or multiple hypodense areas). Serum T4 and/or T3 were increased in 24/52, free T4 in 11/23, and the TSH response to TRH was flat in 8/11 patients. Six of 12 in whom volumetry was performed had goitres. Thirty-seven patients were re-examined after a mean follow-up interval of 46.5 months. At this follow-up, serum T4, free T4 and T3 levels as well as the sonographically determined thyroid volume had decreased, but there was still abnormalities by ultrasound detected in 14/36 patients; 19.4% had focal sonolucent lesions, whereas the prevalence of such lesions was only 3.1% in asymptomatic controls. Three patients were subclinically hypothyroid at the follow-up, whereas all others were euthyroid. Patients with abnormal ultrasound findings were of the same age and had a similar thyroid size, but a slightly higher TSH and a significantly (P<0.02) lower free T4 than those with normal ultrasound findings. They also had a higher prevalence of thyroid autoantibodies in low titres. Serum thyroglobulin was elevated in more than half of the patients during the acute phase, but only in 1 out of 11 patients during follow-up. Thyroglobulin at the follow-up was not related to TSH, but there was a correlation with thyroid volume (r = 0.57). In conclusion, thyroid abnormalities regarding both function and ultrasound findings are sufficiently frequent after SAT to warrant close observation of the patient. Conversely, abnormal ultrasound findings and diminished thyroid function, when not explained by other factors, should suggest the possibility of past SAT.

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Case Report: De Quervain’s Thyroiditis as a Long-Term Sequelae Complication to SARS-CoV-2 Infection

Case Reports in Acute Medicine ◽

10.1159/000517705 ◽

2021 ◽

pp. 64-70

Author(s):

Mark Kong ◽

Sarah La Porte

Keyword(s):

Case Report ◽

Thyroid Function ◽

Elevated Serum ◽

Subacute Thyroiditis ◽

Thyroid Function Tests ◽

Thyroid Function Testing ◽

Neck Lump ◽

Function Testing

A 44-year-old man presented with an enlarged painful lower anterior neck lump with elevated serum concentrations of free thyroxine (T4) and tri-iodothyronine (T3), alongside the presence of antithyroid peroxidase antibodies. Prior to presentation, the patient was demonstrating recovery from a SARS-CoV-2 infection that required sedation, intubation, and invasive ventilation in the intensive care unit (ICU) for 11 days. Ultrasound examination of the thyroid demonstrated features of De Quervain’s (subacute) thyroiditis. This corresponded to the clinical picture, and continuous thyroid function tests were arranged. Emerging evidence throughout the SARS-CoV-2 pandemic describes the long-term sequelae of the infection, including developing atypical effects on the thyroid gland. This case report emphasises the association of painful subacute thyroiditis with post-viral infection and its manifestation during recovery from severe SARS-CoV-2, suggesting that follow-up thyroid function testing should be considered in patients discharged from the ICU who develop neck discomfort.

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Association between ultrasonography echogenicity and heterogeneity and thyroid function in autoimmune diffuse thyroid diseases in children and adolescents

10.21203/rs.3.rs-557677/v1 ◽

2021 ◽

Author(s):

Ji Eun Park ◽

Sook Min Hwang ◽

Ji-Young Hwang ◽

Jin Hee Moon ◽

Ik Yang ◽

...

Keyword(s):

Thyroid Function ◽

Thyroid Dysfunction ◽

Thyroid Stimulating Hormone ◽

Thyroid Diseases ◽

Overt Hypothyroidism ◽

Thyroid Ultrasound ◽

Thyroid Status ◽

Children And Adolescent ◽

Overt Hyperthyroidism

Abstract Purpose: To evaluate the association between thyroid echogenicity and heterogeneity seen on ultrasonography (US) and thyroid function in pediatric and adolescent populations with autoimmune diffuse thyroid diseases (AITD).Methods: From 2000 to 2020, we reviewed thyroid ultrasound (US) images and thyroid function statuses in 133 children and adolescent AITD patients. Our review of the images focused on decreased echogenicity and heterogeneity, which were classified into four grades.Results: Among patients with overt hypothyroidism or overt hyperthyroidism, 94.2% (65/69) showed a US grade of 3 or 4. In patients with subclinical hyper/hypothyroidism or euthyroidism, 45.3% (29/64) showed grades 1 or 2. There were no overt hyper/hypothyroidism patients with US grade 1. When we compared US grades according to thyroid status, more severe thyroid dysfunction was significantly associated with higher US grade (p=0.047). Thyroid stimulating hormone (TSH) level differed significantly according to US grades when we evaluated hyperthyroid (p=0.035) and hypothyroid (p=0.027) states independently. 11 patients showed both US grade and thyroid function status changes on follow-up US.Conclusions: In children and adolescent AITD patients, there was an association between decreased echogenicity and heterogeneity on US and thyroid dysfunction.

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LONG-TERM OUTCOMES OF RADIOIODINE THERAPY FOR JUVENILE GRAVES DISEASE WITH EMPHASIS ON SUBSEQUENTLY DETECTED THYROID NODULES: A SINGLE INSTITUTION EXPERIENCE FROM JAPAN

Endocrine Practice ◽

10.4158/ep-2019-0468 ◽

2020 ◽

Vol 26 (7) ◽

pp. 729-737 ◽

Cited By ~ 1

Author(s):

Tetsuya Mizokami ◽

Katsuhiko Hamada ◽

Tetsushi Maruta ◽

Kiichiro Higashi ◽

Junichi Tajiri

Keyword(s):

Thyroid Gland ◽

Thyroid Nodules ◽

Radioiodine Therapy ◽

Antithyroid Drug ◽

Overt Hypothyroidism ◽

Graves Disease ◽

Outpatient Basis ◽

Long Term Outcomes

Objective: To investigate the long-term outcomes of radioiodine therapy (RIT) for juvenile Graves disease (GD) and the ultrasonographic changes of the thyroid gland. Methods: All of 117 juvenile patients (25 males and 92 females, aged 10 to 18 [median 16] years) who had undergone RIT for GD at our clinic between 1999 and 2018 were retrospectively reviewed. Each RIT session was delivered on an outpatient basis. The maximum 131I dose per treatment was 13.0 mCi, and the total 131I dose per patient was 3.6 to 29.8 mCi (median, 13.0 mCi). 131I administration was performed once in 89 patients, twice in 26, and three times in 2 patients. Ultrasonography of the thyroid gland was regularly performed after RIT. The duration of follow-up after the initial RIT ranged from 4 to 226 (median 95) months. Results: At the latest follow-up more than 12 months after RIT (n = 111), the patients' thyroid functions were overt hypothyroidism (91%), subclinical hypothyroidism (2%), normal (5%), or subclinical hyperthyroidism (2%). New thyroid nodules were detected in 9 patients, 4 to 17 years after initial RIT. Patients with newly detected thyroid nodules underwent RIT with lower doses of 131I and had larger residual thyroid volumes than those without nodules. None of the patients were diagnosed with thyroid cancer or other malignancies during the follow-up period. Conclusion: Over a median follow-up period of 95 months (range, 4 to 226 months), RIT was found to be effective and safe in juvenile GD. However, cumulative evidence from further studies is required to confirm the long-term safety of RIT for juvenile GD. Abbreviations: ATD = antithyroid drug; GD = Graves disease; KI = potassium iodide; LT4 = levothyroxine; MMI = methimazole; PTU = propylthiouracil; RAIU = radio-active iodine uptake; RIT = radioiodine therapy; 99mTc = technetium-99m; TSH = thyrotropin

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