Subacute Thyroiditis Diagnosis and Treatment

Thyroiditis refers to an inflamed thyroid. Your thyroid is a gland in the front of your neck that controls your metabolism by releasing a variety of hormones.

Most types of thyroiditis do not cause pain in the thyroid gland. However, they typically lead to either hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid).

Both of these conditions cause symptoms such as weight changes, anxiety, and fatigue.

Subacute thyroiditis leads to pain and discomfort in the thyroid gland. Individuals with this condition will also have symptoms of overactive thyroid and later develop symptoms of underactive thyroid.

Subacute thyroiditis generally occurs after an upper respiratory viral infection such as the flu or the mumps.

The mumps is a highly contagious viral infection that causes inflamed salivary glands. Subacute thyroiditis is very rare. However, it is slightly more common in middle-aged women.

Symptoms and Signs

There is pain in the anterior neck and fever of 37.8° to 38.3° C. Neck pain characteristically shifts from side to side and may settle in one area, frequently radiating to the jaw and ears.

It is often confused with dental pain, pharyngitis, or otitis and is aggravated by swallowing or turning of the head.

Symptoms of hyperthyroidism are common early in the disease because of hormone release from the disrupted follicles.

There is more lassitude and prostration than in other thyroid disorders. On physical examination, the thyroid is asymmetrically enlarged, firm, and tender.

Diagnosis

  • Clinical findings
  • Free thyroxine (T 4 ) and thyroid-stimulating hormone (TSH) levels
  • ESR
  • Radioactive iodine uptake

Diagnosis is primarily clinical, based on finding an enlarged, tender thyroid in patients with the appropriate clinical history.

Thyroid testing with TSH and at least a free T 4 measurement is usually also done. Radioactive iodine uptake should be measured to confirm the diagnosis. When the diagnosis is uncertain, fine-needle aspiration biopsy is useful.

Thyroid ultrasonography with color Doppler shows reduced blood flow in contrast with the increased flow of Graves’ disease

. Laboratory findings early in the disease include an increase in free T 4 and triiodothyronine (T 3 ), a marked decrease in TSH and thyroid radioactive iodine uptake (often 0), and a high ESR.

After several weeks, the thyroid is depleted of T 4 and T 3 stores, and transient hypothyroidism develops accompanied by a decrease in free T 4 and T 3 , a rise in TSH, and recovery of thyroid radioactive iodine uptake.

Weakly positive thyroid antibodies may be present. Measurement of free T 4 , T 3 , and TSH at 2- to 4-wk intervals identifies the stages of the disease.

Prognosis

Subacute thyroiditis is self-limited, generally subsiding in a few months; occasionally, it recurs and may result in permanent hypothyroidism when follicular destruction is extensive.

How Is Subacute Thyroiditis Treated?

Your doctor will give you medications to help reduce the pain and control inflammation. This is the only treatment necessary in some cases. Possible medications include steroids, aspirin, and ibuprofen.

Your doctor may also want to treat this condition using beta-blocker medications if hyperthyroidism is present in the early stages.

These medications lower blood pressure and reduce symptoms such as irregular heartbeat and nervousness.

However, the treatments for overactive thyroid will be temporary. Your doctor will eventually wean you off any medications that had been prescribed to treat the condition.

Keep in mind that the disease usually occurs in two stages. Treatment for overactive thyroid is important at the beginning of the disease. However, it will not be helpful once your condition progresses into the second phase.

During the later stages of the disease, you will have underactive thyroid. You will generally need to take hormones to replace those that your body is not producing.

What Is the Outlook for Subacute Thyroiditis?

Symptoms will resolve within a year and a half on their own in the majority of cases. However, hypothyroidism may end up being permanent.

The ATA estimates that this occurs in approximately five percent of cases (ATA, 2012).

Source & More Info: Healthline and Merck Manuals

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