subacute (de Quervain or Granulomatous) viral thyroiditis

Introduction 

Subacute thyroiditis is an acute painful disease of the thyroid probably caused by a virus or postinfectious inflammation 

-Measles, mumps, influenza, adenoviruses are among the commonly blamed viruses 

-It occurs between 30 and 50 years of age; it is three to five times more common in females than in males 

-It is often associated with HLA-B35

Symptoms & Signs 

Fever, anterior neck pain, aggravated by swallowing; pain frequently refers to the ear; a markedly tender thyroid gland upon palpation with one or more nodules; in the acute phase the patient may be euthyroid or hyperthyroid

Diagnosis 

Labs: Early hyperthyroidism is followed by a hypothyroid phase and later euthyroid phase

Biopsy: Lymphocytes and multinucleated giant cells

Treatment 

Aspirin, NSAIDS, glucocorticoids, β-adrenergic blockers; monitor TSH, T4 every two weeks; Complete recovery in most cases