Subacute thyroiditis and its clinical characteristics — a retrospective single center clinical study

INTRODUCTION. Typical clinical features of subacute thyroiditis (SAT) are commonly assessed such as – neck pain and high body temperature, as well as thyroid function abnormalities, elevated inflammatory markers, and strongly suggestive hypoechoic ultrasonography characteristics. Non-steroid anti-inflammatory agents and corticosteroids are used.

AIM. To examine the clinical characteristics in patients with SAT, by determining the level of thyroid hormones, the size and structure of the thyroid gland as well as ultrasound and scintigraphy findings.

MATERIALS AND METHODS. We performed retrospective analysis in 122 cases of SAT (both genders, mean age 45.05±12,18 years), in the period 2015-2020. We evaluated monthly frequency of the SAT occurrence, the clinical status of the patients including symptoms, body temperature, laboratory results of FT4 and TSH, CRP and ESR level, ultrasonography and scintigraphy findings.

RESULTS. Most of the patients complained of neck pain, high body temperature was detected in 66/100 (66%) pts. CRP and ESR Patients were usually diagnosed in hyperthyroid phase of the disease. Enlarged thyroid gland was mostly seen on US, while 52 had normal thyroid gland, with predominantly hypoechoic non-chomogenous structure. Scintigraphy noted “empty” scan (without presentation of functional thyroid tissue) in 72/98 (73,47%) and hypofixation mainly in both lobes in 26/98 (26,53%) pts.

CONCLUSION. The awareness of physicians needs to be increased in patients with neck pain for proper diagnosis of SAT, that is often is often misdiagnosed or delayed, leading to erroneous antibiotic overuse. Generally, nonsteroidal anti-inflammatory drugs are effective in reducing thyroid pain in patients with mild cases.

1. Trimboli P, Cappelli C, Croce L, et al. COVID-19-Associated Subacute Thyroiditis: Evidence-Based Data From a Systematic Review. Front Endocrinol (Lausanne). 2021;12(15):e15133. doi: https://doi.org/10.3389/fendo.2021.707726

2. Oláh R, Hajós P, Soós Z, Winkler G. De Quervain thyroiditis. Corner points of the diagnosis. Orv Hetil. 2014;155(17):676-680. doi: https://doi.org/10.1556/OH.2014.29865

3. Stasiak M, Lewiński A. New aspects in the pathogenesis and management of subacute thyroiditis. Rev Endocr Metab Disord. 2021;22(4):1027-1039. doi: https://doi.org/10.1007/s11154-021-09648-y

4. Desailloud R, Hober D. Viruses and thyroiditis: an update. Virol J. 2009;6(1):5. doi: https://doi.org/10.1186/1743-422X-6-5

5. Volpé R. The Management of Subacute (DeQuervain’s) Thyroiditis. Thyroid. 1993;3(3):253-255. doi: https://doi.org/10.1089/thy.1993.3.253

6. Quervain F. Über acute, nichteitrige thyroiditis. Arch Für Klin Chir. 1902;67:706-714.

7. Michas G, Alevetsovitis G, Andrikou I, et al. De Quervain thyroiditis in the course of H1N1 influenza infection. Hippokratia. 2014;18(1):86-87.

8. Anaforoğlu İ, Topbas M. Clinical characteristics of patients with subacute thyroidits and factors affecting development hypothyroidism after subacute thyroiditis. Arch Med Sci. 2022. doi: https://doi.org/10.5114/aoms/145481

9. Fatourechi V, Aniszewski JP, Fatourechi GZE, et al. Clinical Features and Outcome of Subacute Thyroiditis in an Incidence Cohort: Olmsted County, Minnesota, Study. J Clin Endocrinol Metab. 2003;88(5):2100-2105. doi: https://doi.org/10.1210/jc.2002-021799

10. Weetman AP, Smallridge RC, Nutman TB, Burman KD. Persistent thyroid autoimmunity after subacute thyroiditis. J Clin Lab Immunol. 1987;23(1):1-6.

11. Kojima M, Nakamura S, Oyama T, et al. Cellular Composition of Subacute Thyroiditis. An Immunohistochemical Study of Six Cases. Pathol Res Pract. 2002;198(12):833-837. doi: https://doi.org/10.1078/0344-0338-00344

12. Park SY, Kim E-K, Kim MJ, et al. Ultrasonographic Characteristics of Subacute Granulomatous Thyroiditis. Korean J Radiol. 2006;7(4):229-234. doi: https://doi.org/10.3348/kjr.2006.7.4.229

13. Cappelli C, Pirola I, Gandossi E, et al. Ultrasound findings of subacute thyroiditis: a single institution retrospective review. Acta Radiol. 2014;55(4):429-433. doi: https://doi.org/10.1177/0284185113498721

14. Zhao N, Wang S, Cui X-J, et al. Two-Years Prospective Follow-Up Study of Subacute Thyroiditis. Front Endocrinol (Lausanne). 2020;11(4):229. doi: https://doi.org/10.3389/fendo.2020.00047

15. Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid. 2016;26(10):1343-1421. doi: https://doi.org/10.1089/thy.2016.0229

16. Hennessey Jv. Subacute Thyroiditis. [Updated 2018 Jun 12]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText. com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279084/

17. Benbassat CA, Olchovsky D, Tsvetov G, Shimon I. Subacute thyroiditis: Clinical characteristics and treatment outcome in fifty-six consecutive patients diagnosed between 1999 and 2005. J Endocrinol Invest. 2007;30(8):631-635. doi: https://doi.org/10.1007/BF03347442

18. Erdem N, Erdogan M, Ozbek M, et al. Demographic and clinical features of patients with subacute thyroiditis: Results of 169 patients from a single University Center in Turkey. J Endocrinol Invest. 2007;30(7):546-550. doi: https://doi.org/10.1007/BF03346347

19. Zhao N, Wang S, Cui X-J, et al. Two-Years Prospective Follow-Up Study of Subacute Thyroiditis. Front Endocrinol (Lausanne). 2020;11(7):546-550. doi: https://doi.org/10.3389/fendo.2020.00047