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For further information, see CMDT Part 26-07: Thyroiditis

Key Features

Essentials of Diagnosis

Autoimmune thyroiditis

  • Chronic lymphocytic (Hashimoto) thyroiditis is the most common thyroiditis and often progresses to hypothyroidism

  • Postpartum thyroiditis and subacute lymphocytic thyroiditis (silent thyroiditis) can cause transient hyperthyroidism due to passive release of stored thyroid hormone

  • Thyroid peroxidase antibodies (TPO Ab) or thyroglobulin antibodies (Tg Ab) are usually high

Painful subacute thyroiditis (de Quervain thyroiditis)

  • Hallmark is tender thyroid gland with painful dysphagia

  • Elevated erythrocyte sedimentation rate (ESR)

  • Viral etiology. Antithyroid antibodies are absent or low, distinguishing it from autoimmune thyroiditis.

Infectious (suppurative) thyroiditis

  • Severe, painful thyroid gland

  • Febrile with leukocytosis and elevated ESR

IgG4-related thyroiditis (Riedel thyroiditis)

  • Most often in middle age or older women

  • Usually part of a systemic fibrosing syndrome

General Considerations

Autoimmune thyroiditis

  • Chronic lymphocytic thyroiditis, also known as "Hashimoto thyroiditis," is the most common thyroid disorder in the United States

  • Often progresses to hypothyroidism

  • Incidence of autoimmune thyroiditis varies by kindred, race, and sex; it is commonly familial

  • In the United States, elevated levels of antithyroid antibodies are found in

    • 14.3% of Whites

    • 10.9% of Mexican Americans

    • 5.3% of Blacks

  • Dietary iodine supplementation (especially when excessive) increases the risk of autoimmune thyroiditis

  • Certain medications can trigger autoimmune thyroiditis, including

    • Tyrosine kinase inhibitors

    • Alemtuzumab

    • Interferon-alpha

    • Interleukin-2

    • Thalidomide, lenalidomide

    • Lithium

    • Amiodarone

    • Immune checkpoint inhibitors

  • Thyroiditis is frequently associated with other autoimmune conditions

    • Pernicious anemia

    • Sjögren syndrome

    • Vitiligo

    • Inflammatory bowel disease, celiac disease, and gluten sensitivity

  • Chronic hepatitis C

    • Associated with an increased risk of autoimmune thyroiditis

    • 21% of affected patients having antithyroid antibodies

    • 13% having hypothyroidism

  • Postpartum thyroiditis

    • An acute autoimmune thyroiditis that occurs soon after delivery in about 7% of women

    • Most women recover normal thyroid function

    • Occurs commonly in women who have

      • High levels of TPO Ab in the first trimester of pregnancy or immediately after delivery

      • Preexistent type 1 diabetes mellitus

      • Other autoimmunity

      • Family history of autoimmune thyroiditis

  • Painless (silent) sporadic subacute thyroiditis

    • A form of autoimmune thyroiditis that is similar to postpartum thyroiditis, except that it is not related to pregnancy

    • Causes include amiodarone and immunotherapy

    • Accounts for about 1% of cases of thyrotoxicosis and is followed by hypothyroidism that may resolve spontaneously

Painful subacute thyroiditis

  • Also called de Quervain thyroiditis, granulomatous thyroiditis, and giant cell thyroiditis

  • Relatively common

  • Most affected patients have transient hyperthyroidism, followed by hypothyroidism

  • Typically associated with a viral infection (including COVID-19) and often follows an upper respiratory tract infection

  • Incidence peaks in the summer to early autumn

  • Affects both sexes; young and middle-aged women are most commonly affected

Infectious (suppurative) thyroiditis
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