A tendency to appear in the spring in the northern latitudes has been noted and again it. Autoimmune thyroid disease has been reported in association with sarcoidosis as well as rheumatoid arthritis, diseases in. Subacute thyroiditis knowledge for medical students and. Thyroiditis journal of association of physicians of india. Diagnosis is clinical and with thyroid function tests. Rare, much less common than hashimoto thyroiditis but most common cause of thyroid pain. Subacute thyroiditis is generally caused by viral infection and is the most common cause of a painful thyroid 1, 3.
Steroid medication is considered to be the therapeutic choice but careful observation is necessary to avoid a recurrence. Initial treatment with 15 mg of prednisolone daily is sufficient for most patients with subacute thyroiditis in japan. Also you can find parafollicular cells white arrow which secrete calcitonin. It is an uncommon process that may go undetected if the sonographic findings are not recognized or if.
A total of 31 lesions from 27 patients were confirmed. The administration of high doses of thyroid hormone is a common cause of. The thyroid web atlas contains 300 images of key thyroid lesions in an easytosearch format. Few studies have been reported from the kingdom of saudi arabia sa to describe the clinical presentation and long term outcomes of subacute thyroiditis sat. The thyroid is often enlarged and firm to palpation.
Subacute granulomatous thyroiditis has been described by many names. Pain over the thyroid area that is gradual or of sudden onset. These follicles are lined by follicular cells black arrow. Thyroglobulin is degraded by serum proteases into the thyroid hormones levothyroxine t4 and triiothyronine t3. Subacute thyroiditis endocrine and metabolic disorders. While subacute granulomatous thyroiditis usually occurs after a viral upper respiratory tract infection, subacute lymphocytic thyroiditis occurs either during the. Adults present with painless, gradual thyroid failure due to autoimmune destruction, may initially have transient hyperthyroidism children have variable hypothyroidism and reversion to euthyroidism so must monitor thyroid function clin endocrinol oxf 2009. The clinical course includes an initial phase of hyperthyroidism, followed by a phase of hypothyroidism, and eventually a return to normal thyroid function. Indirect evidence has implicated viral infection in the etiology of subacute thyroiditis. Dqt, also known as subacute granulomatous thyroiditis is a. Subacute thyroiditis is a selflimited thyroid condition associated with a triphasic clinical course of hyperthyroidism, hypothyroidism, and return to normal thyroid function.
This is subacute granulomatous thyroiditis dequervain disease, which probably follows a viral infection and leads to a painful enlarged thyroid. Subacute thyroiditis an overview sciencedirect topics. In our practice the ratio of dq to hashimotos thyroiditis ht is around 1 to 30. Areas of thyroid affected by the disease show intrafollicular cellular infiltration, with partial or complete. Ivan damjanov md, phd, in pathology secrets third edition, 2009.
Which histologic findings are characteristic of subacute. Rare, much less common than hashimoto thyroiditis but most common cause of thyroid. In 1948, crile24 emphasized the fact that the clinical entity then recognized as subacute thyroiditis is histopathologically identical with pseudotuberculous. Thyroiditis subacute thyroiditis subacute thyroiditis follows the same clinical course as painless and postpartum thyroiditis, but is often accompanied by thyroidal pain. It is a granulomatous inflammatory condition which leads finally to fibrosis of the gland. The diagnosis and management of several of the individual disorders, ie, subacute thyroiditis or subacute granulomatous thyroiditis, painless thyroiditis, and postpartum thyroiditis, are discussed in more detail elsewhere, as is chronic autoimmune thyroiditis hashimotos thyroiditis. Subacute thyroiditis may be responsible for 1520% of patients presenting with thyrotoxicosis and 10% of patients presenting with hypothyroidism. In neither case is there an obvious cause of granuloma formation, the only accompanying abnormality being rheumatoid arthritis in one of the patients. This condition, unlike hashimotos disease, rarely causes permanent hypothyroidism. Subacute thyroiditis is a rare type of thyroiditis that causes pain and discomfort in the thyroid. Histological, clinical and laboratory findings of acute. Cellular smears with clustered epithelioid cells, fibrous fragments with enmeshed inflammatory cells, scattered lymphocytes, histiocytes and neutrophils, occasional multinucleated giant cells containing up to 100 nuclei and ingesting colloid or neutrophils. Silent thyroiditis, also called subacute lymphocytic thyroiditis, classically presents with the same triphasic course described earlier for subacute thyroiditis. Subacute granulomatous thyroiditis definition of subacute.
It is the most common cause of thyroid pain and patients usually. Potential characterizations have included riedels thyroiditis as a thyroid or cervical location for a systemic fibrosing disorder with identical histopathological features, a variant of hashimotos thyroiditis, a primary inflammatory disorder of the thyroid, or even a manifestation of endstage subacute thyroiditis 1, 11, 12. Subacute granulomatous thyroiditis differentials bmj. The thyroidal pain in patients with subacute thyroiditis usually follows the same timeframe of the thyrotoxic phase months. We wanted to describe the characteristic ultrasonography us features and clinical findings for making the diagnosis of subacute granulomatous thyroiditis. While subacute granulomatous thyroiditis usually occurs after a viral upper respiratory tract infection, subacute lymphocytic thyroiditis occurs either during the postpartum period, in association with other autoimmune diseases, or as a side effect of certain. A case of granulomatosis with polyangiitis preceded by. Subacute granulomatous thyroiditis bmj best practice. Ultrasonographic characteristics of subacute granulomatous. Subacute thyroiditis subacute granulomatous thyroiditis is characterized by neck pain or discomfort, a tender diffuse goiter, and a predictable course of thyroid function evolution.
Subacute thyroiditis refers to a transient patchy inflammation of the thyroid gland that is associated either with granuloma formation subacute granulomatous thyroiditis or lymphocytic infiltration subacute lymphocytic thyroiditis. Another type, called subacute granulomatous thyroiditis, is characterized by thyroid pain and tenderness. Inflammation of the thyroid characterized by a triphasic course of transient thyrotoxicosis, followed by hypothyroidism, followed by return to euthyroidism. A tendency to appear in the spring in the northern latitudes has been noted and again it predominates in the female. Pdf cooccurrence of subacute granulomatous thyroiditis. Papillary carcinoma obscured by complication with subacute. It is associated with a triphasic clinical course that lasts for a few weeks to many months, characterized by transient thyrotoxicosis, hypothyroidism, and then a return to normal thyroid function in 90% of patients. Subacute thyroiditis msd manual professional edition. Acute and subacute, and riedels thyroiditis rupendra t. Subacute granulomatous thyroiditis pathology student. Oct 08, 2018 the treatment of subacute thyroiditis is generally supportive to reduce the symptoms of thyrotoxicosis and to control neck pain in the setting of subacute granulomatous thyroiditis. Subacute granulomatous thyroiditis is a dynamic process, and usg and cytological findings may vary according to the stage of the disease. Thyroid is nontender or minimally tender compared with the extremely tender gland with subacute granulomatous thyroiditis. The aims of the study are to identify the diagnostic cytological features of subacute granulomatous thyroiditis sgt, to compare our results with previous literature studies, and to investigate the cytological changes in sgt that mimic other thyroid lesions.
Ultrasonographic characteristics of subacute granulomatous thyroiditis objective. May have extrathyroidal manifestations, such as ophthalmopathy or pretibial myxedema thyroid dermopathy. Abstract background the aims of the study are to identify the diagnostic cytological features of subacute granulomatous thyroiditis sgt. It is defined by the presence of mononuclear leukocytes, specifically histiocytes macrophages, which respond to various chemical mediators of cell injury. Several days after the infection begins, the patient develops severe neck.
A normal esr essentially rules out the diagnosis of subacute granulomatous thyroiditis. Kubota s, nishihara e, kudo t, ito m, amino n, miyauchi a. Subacute granulomatous thyroiditis symptoms, diagnosis. Histopathology images of hashimoto thyroiditis by pathpedia. Subacute thyroiditis is treated effectively by a low dose of prednisolone jerome m. Subacute thyroiditis painful subacute thyroiditis, 5% of clinical thyroid disease, often follows a viral upper respiratory illness mumps, coxsackie, influenza and adenovirus. Also called acute thyroiditis via blood or direct seeding from upper respiratory infections, causes sudden onset of pain and glandular enlargement risk factors. The objective of the study was to assess sequential ultrasonographic and histopathological findings of sat in the context of complicating thyroid carcinomas. It may persist from several weeks to a few months but subsides spontaneously. Get a printable copy pdf file of the complete article 5. Under a scanning electron microscope, the cytomorphology of subacute granulomatous thyroiditis shows loss of a uniform honeycomb cellular arrangement, variation in size and decreased or. Subacute granulomatous thyroiditis is a selflimited inflammation of the thyroid gland.
While the onset is acute, the disease may run a variable course of indefinite duration. All structured data from the file and property namespaces is available under the creative commons cc0 license. The thyrotoxic phase is due to thyroid follicular damage and release of preformed hormone, and is characterized by very low thyroid uptake o. It is thought to be the result of a viral infection. In a typical case a patient had an upper airway infection 36 weeks prior to. Subacute thyroiditis sat has been rarely reported to coexist with thyroid carcinomas. Two cases of granulomatous inflammation of the thyroid gland associated with hashimotos thyroiditis are presented. Diagnostic cytological features and differential diagnosis. Subacute granulomatous thyroiditis etiology bmj best.
Granulomatous inflammation is a distinctive form of chronic inflammation produced in response to various infectious, autoimmune, toxic, allergic, and neoplastic conditions. Although there is no special radiological finding of thyroiditis, hypoechoic and heterogeneous areas with irregular margins in the thyroid are strongly associated with thyroiditis. Initial hyperthyroidism is common, sometimes followed by a transient period of hypothyroidism. Painful swallowing odynophagia, sore throat, thyroid region tenderness, fever, fatigue, malaise. Inflammation of thyroid gland that includes granulomas. Because no new hormone is being made, antithyroid medications are not effective in these conditions. Lymphocytic thyroiditis also known as subacute painless thyroiditis.
This disease is usually selflimited over weeks to months, with transient hyperthyroidism andor hypothyroidism, and affected patients return to a euthyroid state. Subacute thyroiditis is treated effectively by a low dose of. Important to differentiate from the acute bacterial infection of acute suppurative thyroiditis ast is subacute granulomatous thyroiditis sat which is far more common than ast and is. Oct 08, 2018 subacute thyroiditis is a selflimited thyroid condition associated with a triphasic clinical course of hyperthyroidism, hypothyroidism, and return to normal thyroid function. Fever, dysphagia, malaise, fatigue, anxiety, sweats may occur.
Several days after the infection begins, the patient develops severe neck pain, sometimes radiating to the ear. Thyrotoxicosis during pregnancy is a rare condition and. Files are available under licenses specified on their description page. Hyperthyroidism is typically the presentation followed by euthyroidism, hypothyroidism, and ultimately restoration of normal thyroid function figure 1. In this article, we present a case of subacute thyroiditis occurring in the first trimester of pregnancy in a 33yearsold pregnant patient. Thyroid is exquisitely tender, hard, mild to moderately. Hyperthyroidism in patients with thyroiditis is usually mild and selflimiting, lasting only until the stores of hormone in the thyroid gland are exhausted. Apr 27, 2009 subacute granulomatous thyroiditis is a selflimiting inflammatory disorder of the thyroid that occurs following a viral upper respiratory tract infection usually adenovirus or coxsackievirus.
Subacute thyroiditis is an acute inflammatory disease of the thyroid probably caused by a virus. A case of granulomatosis with polyangiitis preceded by subacute thyroiditis. Pdf a case of granulomatosis with polyangiitis preceded by. The thyroidal pain in patients with subacute thyroiditis usually follows the same timeframe of. People with this condition will also have symptoms of hyperthyroidism and later develop symptoms. Subacute granulomatous thyroiditis is a selflimiting inflammatory disorder of the thyroid that occurs following a viral upper respiratory tract infection usually adenovirus or coxsackievirus. Subacute granulomatous thyroiditis is a destructive thyroiditis that results in the release of preformed thyroid hormones, in the form of thyroglobulin, into the circulation. This inflammation is granulomatous, meaning there are aggregations of immune cells, mainly activated macrophages, that form tiny nodules within the thyroid gland. The condition often occurs a few weeks after a viral infection of the ear, sinus, or throat, such as mumps, the flu, or a common cold. Hyperthyroidism is typically the presentation followed by euthyroidism, hypothyroidism, and ultimately restoration of normal thyroid function.
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