Subacute thyroiditis painful subacute thyroiditis, 5% of clinical thyroid disease, often follows a viral upper respiratory illness mumps, coxsackie, influenza and adenovirus. It is a granulomatous inflammatory condition which leads finally to fibrosis of the gland. People with this condition will also have symptoms of hyperthyroidism and later develop symptoms. 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. Indirect evidence has implicated viral infection in the etiology of subacute thyroiditis. Hyperthyroidism is typically the presentation followed by euthyroidism, hypothyroidism, and ultimately restoration of normal thyroid function. Initial treatment with 15 mg of prednisolone daily is sufficient for most patients with subacute thyroiditis in japan. 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.
Ivan damjanov md, phd, in pathology secrets third edition, 2009. A total of 31 lesions from 27 patients were confirmed. Subacute granulomatous thyroiditis symptoms, diagnosis. In 1948, crile24 emphasized the fact that the clinical entity then recognized as subacute thyroiditis is histopathologically identical with pseudotuberculous. Diagnostic cytological features and differential diagnosis.
This is subacute granulomatous thyroiditis dequervain disease, which probably follows a viral infection and leads to a painful enlarged thyroid. Steroid medication is considered to be the therapeutic choice but careful observation is necessary to avoid a recurrence. The thyrotoxic phase is due to thyroid follicular damage and release of preformed hormone, and is characterized by very low thyroid uptake o. 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. Lymphocytic thyroiditis also known as subacute painless thyroiditis. Localized subacute thyroiditis presenting as a painful hot. The administration of high doses of thyroid hormone is a common cause of. Subacute granulomatous thyroiditis is a destructive thyroiditis that results in the release of preformed thyroid hormones, in the form of thyroglobulin, into the circulation. Files are available under licenses specified on their description page.
Subacute granulomatous thyroiditis has been described by many names. The thyroid is often enlarged and firm to palpation. Abstract background the aims of the study are to identify the diagnostic cytological features of subacute granulomatous thyroiditis sgt. Subacute granulomatous thyroiditis is a selflimiting inflammatory disorder of the thyroid that occurs following a viral upper respiratory tract infection usually adenovirus or coxsackievirus. 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. Get a printable copy pdf file of the complete article 5. Several days after the infection begins, the patient develops severe neck. Subacute thyroiditis an overview sciencedirect topics.
Papillary carcinoma obscured by complication with subacute. Subacute thyroiditis endocrine and metabolic disorders. Thyrotoxicosis during pregnancy is a rare condition and. These follicles are lined by follicular cells black arrow.
A tendency to appear in the spring in the northern latitudes has been noted and again it. It may persist from several weeks to a few months but subsides spontaneously. Subacute thyroiditis is an acute inflammatory disease of the thyroid probably caused by a virus. Subacute granulomatous thyroiditis definition of subacute. Subacute granulomatous thyroiditis bmj best practice. Subacute thyroiditis subacute granulomatous thyroiditis is characterized by neck pain or discomfort, a tender diffuse goiter, and a predictable course of thyroid function evolution. Ultrasonographic characteristics of subacute granulomatous thyroiditis objective. Rare, much less common than hashimoto thyroiditis but most common cause of thyroid. Thyroid is nontender or minimally tender compared with the extremely tender gland with subacute granulomatous thyroiditis.
Diagnosis is clinical and with thyroid function tests. 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. Inflammation of the thyroid characterized by a triphasic course of transient thyrotoxicosis, followed by hypothyroidism, followed by return to euthyroidism. 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. In neither case is there an obvious cause of granuloma formation, the only accompanying abnormality being rheumatoid arthritis in one of the patients. Subacute thyroiditis is a rare type of thyroiditis that causes pain and discomfort in the thyroid.
Which histologic findings are characteristic of subacute. 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 is treated effectively by a low dose of. Subacute thyroiditis knowledge for medical students and. Painful swallowing odynophagia, sore throat, thyroid region tenderness, fever, fatigue, malaise. Dqt, also known as subacute granulomatous thyroiditis is a. Subacute thyroiditis is treated effectively by a low dose of prednisolone jerome m. Subacute granulomatous thyroiditis etiology bmj best. 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. The clinical course includes an initial phase of hyperthyroidism, followed by a phase of hypothyroidism, and eventually a return to normal thyroid function. Areas of thyroid affected by the disease show intrafollicular cellular infiltration, with partial or complete. We wanted to describe the characteristic ultrasonography us features and clinical findings for making the diagnosis of subacute granulomatous thyroiditis. A case of granulomatosis with polyangiitis preceded by subacute thyroiditis. While the onset is acute, the disease may run a variable course of indefinite duration.
The thyroidal pain in patients with subacute thyroiditis usually follows the same timeframe of. Ultrasonographic characteristics of subacute granulomatous. In our practice the ratio of dq to hashimotos thyroiditis ht is around 1 to 30. Although there is no special radiological finding of thyroiditis, hypoechoic and heterogeneous areas with irregular margins in the thyroid are strongly associated with thyroiditis. 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 granulomatous thyroiditis pathology student. Autoimmune thyroid disease has been reported in association with sarcoidosis as well as rheumatoid arthritis, diseases in. In a typical case a patient had an upper airway infection 36 weeks prior to. Silent thyroiditis, also called subacute lymphocytic thyroiditis, classically presents with the same triphasic course described earlier for subacute thyroiditis. A case of granulomatosis with polyangiitis preceded by. Thyroglobulin is degraded by serum proteases into the thyroid hormones levothyroxine t4 and triiothyronine t3. Acute and subacute, and riedels thyroiditis rupendra t.
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. Rare, much less common than hashimoto thyroiditis but most common cause of thyroid pain. The thyroid web atlas contains 300 images of key thyroid lesions in an easytosearch format. Several days after the infection begins, the patient develops severe neck pain, sometimes radiating to the ear. It is thought to be the result of a viral infection. Pdf subacute thyroiditis, which is most commonly observed after a viral infection and may heal spontaneously, is an inflammatory thyroid disease. A normal esr essentially rules out the diagnosis of subacute granulomatous thyroiditis. Because no new hormone is being made, antithyroid medications are not effective in these conditions. 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. Histopathology images of hashimoto thyroiditis by pathpedia. 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. It is the most common cause of thyroid pain and patients usually. Subacute granulomatous thyroiditis differentials bmj. Subacute granulomatous thyroiditis is a dynamic process, and usg and cytological findings may vary according to the stage of the disease.
This condition, unlike hashimotos disease, rarely causes permanent hypothyroidism. Hyperthyroidism in patients with thyroiditis is usually mild and selflimiting, lasting only until the stores of hormone in the thyroid gland are exhausted. This inflammation is granulomatous, meaning there are aggregations of immune cells, mainly activated macrophages, that form tiny nodules within the thyroid gland. Subacute thyroiditis is a selflimited thyroid condition associated with a triphasic clinical course of hyperthyroidism, hypothyroidism, and return to normal thyroid function. Subacute thyroiditis may be responsible for 1520% of patients presenting with thyrotoxicosis and 10% of patients presenting with hypothyroidism. Pdf a case of granulomatosis with polyangiitis preceded by. Pain over the thyroid area that is gradual or of sudden onset. Another type, called subacute granulomatous thyroiditis, is characterized by thyroid pain and tenderness. Initial hyperthyroidism is common, sometimes followed by a transient period of hypothyroidism. 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. It is an uncommon process that may go undetected if the sonographic findings are not recognized or if. While subacute granulomatous thyroiditis usually occurs after a viral upper respiratory tract infection, subacute lymphocytic thyroiditis occurs either during the.
Subacute thyroiditis sat has been rarely reported to coexist with thyroid carcinomas. Hyperthyroidism is typically the presentation followed by euthyroidism, hypothyroidism, and ultimately restoration of normal thyroid function figure 1. Histological, clinical and laboratory findings of acute. This disease is usually selflimited over weeks to months, with transient hyperthyroidism andor hypothyroidism, and affected patients return to a euthyroid state. It is defined by the presence of mononuclear leukocytes, specifically histiocytes macrophages, which respond to various chemical mediators of cell injury.
Pdf cooccurrence of subacute granulomatous thyroiditis. The objective of the study was to assess sequential ultrasonographic and histopathological findings of sat in the context of complicating thyroid carcinomas. Also you can find parafollicular cells white arrow which secrete calcitonin. All structured data from the file and property namespaces is available under the creative commons cc0 license. The thyroidal pain in patients with subacute thyroiditis usually follows the same timeframe of the thyrotoxic phase months.
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. Subacute thyroiditis msd manual professional edition. The acute exacerbation of hashimotos thyroiditis is a rare complication, which is found to be different from subacute thyroiditis on histological, clinical and laboratory findings and is generally subtle. In this article, we present a case of subacute thyroiditis occurring in the first trimester of pregnancy in a 33yearsold pregnant patient. Thyroiditis subacute thyroiditis subacute thyroiditis follows the same clinical course as painless and postpartum thyroiditis, but is often accompanied by thyroidal pain. Subacute granulomatous thyroiditis approach bmj best practice. Thyroid is exquisitely tender, hard, mild to moderately. Inflammation of thyroid gland that includes granulomas. This category includes the subacute lymphocytic thyroiditis and subacute granulomatous thyroiditis. Subacute thyroiditis is generally caused by viral infection and is the most common cause of a painful thyroid 1, 3. A tendency to appear in the spring in the northern latitudes has been noted and again it predominates in the female. 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. Fever, dysphagia, malaise, fatigue, anxiety, sweats may occur. May have extrathyroidal manifestations, such as ophthalmopathy or pretibial myxedema thyroid dermopathy.
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