Thyroiditis
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thyroiditis overview diagnosis management American Thyroid Association
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https://www.thyroid.org/thyroiditis
Thyroiditis
Thyroiditis means inflammation and injury of the thyroid gland. It is a group of disorders, not one disease. In many forms, damaged thyroid cells release preformed hormone, causing a temporary thyrotoxic phase, often followed by a hypothyroid phase as hormone stores are depleted. This is hormone leakage, not increased hormone synthesis. Textbook of Family Medicine 9e, p. 1023.
Common types
| Type | Typical features | Usual outcome |
|---|---|---|
| Hashimoto thyroiditis | Autoimmune, usually painless; goiter may occur; commonly presents with hypothyroidism | Often permanent hypothyroidism |
| Subacute thyroiditis (de Quervain) | Painful tender thyroid, often after viral illness; fever, raised ESR/CRP; transient thyrotoxicosis then hypothyroidism | Usually recovers over 12-18 months; a minority develop permanent hypothyroidism |
| Painless/silent thyroiditis | Painless transient thyrotoxicosis, often followed by hypothyroidism | Usually recovers |
| Postpartum thyroiditis | Painless autoimmune thyroiditis within the first year after delivery | May resolve, but some develop lasting hypothyroidism |
| Acute suppurative/infectious thyroiditis | Neck pain, fever, systemic infection, sometimes abscess | Requires urgent antimicrobial assessment and possible drainage |
| Drug/radiation-induced | Can follow drugs such as amiodarone or interferon, or neck radiation | Depends on cause; radiation-related hypothyroidism is often permanent |
| Riedel thyroiditis | Rare, very hard fibrotic thyroid that may cause pressure symptoms | Specialist assessment required |
Painful forms include subacute and infectious thyroiditis; Hashimoto, painless/postpartum, Riedel, and many drug-induced forms are generally painless. Current Surgical Therapy 14e, p. 884.
Symptoms
Thyrotoxic phase
- Palpitations, tremor, anxiety, heat intolerance
- Sweating, weight loss, insomnia
- Fatigue and irritability
Hypothyroid phase
- Fatigue, weight gain, cold intolerance
- Constipation, dry skin, low mood
- Slower thinking and reduced exercise tolerance
Painful subacute disease
- Pain and tenderness at the front of the neck, sometimes radiating to jaw or ears
- Fever and malaise
Diagnosis
Typical assessment includes:
- TSH and free T4, sometimes T3
- TPO antibodies and thyroglobulin antibodies when Hashimoto or postpartum thyroiditis is suspected
- ESR/CRP, often raised in subacute thyroiditis
- Thyroid ultrasound if there is a lump, asymmetry, uncertainty, or compressive symptoms
- Radioactive iodine uptake scan in selected thyrotoxic cases: thyroiditis usually has low uptake, unlike Graves disease
Hashimoto thyroiditis is an autoimmune disorder with antibodies to thyroid peroxidase and thyroglobulin in most patients, causing progressive thyroid destruction. Robbins, Cotran & Kumar Pathologic Basis of Disease, p. 998. The American Thyroid Association overview similarly distinguishes destructive thyrotoxicosis in thyroiditis from true hormone overproduction in Graves disease.
Treatment principles
Treatment depends on the type and phase:
- Thyrotoxic symptoms: a beta-blocker may be used for troublesome palpitations or tremor.
- Antithyroid drugs such as methimazole generally do not help ordinary destructive thyroiditis because the gland is not overproducing hormone.
- Subacute painful thyroiditis: anti-inflammatory treatment, often NSAIDs; corticosteroids may be considered for severe or refractory pain under clinician supervision.
- Hypothyroid phase: levothyroxine if hypothyroidism is overt, persistent, symptomatic, or clinically indicated. Hashimoto-related hypothyroidism often needs lifelong replacement.
- Infectious thyroiditis: urgent medical evaluation, antibiotics directed to likely infection, and drainage if abscess is present.
- Drug-induced thyroiditis: medication review with the prescriber. Do not stop prescribed drugs such as amiodarone without medical direction.
Seek urgent care now if there is
- Fever with severe neck pain, swelling, redness, or trouble swallowing
- Breathing difficulty, noisy breathing, or rapidly enlarging neck swelling
- Persistent fast heart rate, chest pain, fainting, or severe agitation
- New thyroid symptoms during pregnancy or after delivery
A recent PubMed screen did not identify a broad new systematic review that changes these standard subtype-based principles; it mainly returned disease-association reviews rather than updated general thyroiditis management evidence.
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