What is Subacute (Nonsuppurative or
'de Quervain's') Thyroiditis?

This condition was first described in 1904. It is caused by a viral infection characterised by an enlarged tender thyroid with fever, muscle aches and malaise. There is a phase of thyroid overactivity followed by under activity and finally the thyroid function returns to normal (Euthyroid). The disease is usually self-limiting. There is no evidence that t is a premalignant condition.

The diagnosis is made by the clinical findings. During the acute phase the serumT3 and T4 concentrations are elevated, these then become subnormal in those patients who enter a hypothyroid phase.There is a high blood sedimentation rate (ESR) and evidence of no uptake on the thyroid nuclear scan. The pathology is typical with giant cells hence the condition is sometimes called giant cell thyroidtis. ( see picture below)

Treatment is directed at controlling the pain and aspirin is effective; rarely a short course of steroids is needed. In some patients who have a significant hypothyroid phase treatment with thyroxine is necessary, but rarely needs to extend beyond 3 to 4 months.There is no indication for surgery unless fine needle aspiration raises doubts about the diagnosis.