Subacute Lymphocytic Thyroiditis

Aka: Subacute Lymphocytic Thyroiditis, Silent Sporadic Thyroiditis, Painless Sporadic Thyroiditis, Silent Thyroiditis

advertisement

II. Pathophysiology

  1. Autoimmune lymphocytic infiltration of Thyroid
  2. Results in Thyroid follicle destruction with release of preformed Thyroid Hormone

III. Epidemiology

  1. More common in women by 4 fold

IV. Signs

  1. Painless Goiter (50%)
  2. Hyperthyroidism (up tp 20%)
    1. Duration: Typically <4 months
    2. Followed by Hypothyroidism and then euthyroid

V. Differential Diagnosis

  1. Drug-Induced Thyroiditis
    1. See Drug-Induced Thyroiditis
  2. Postpartum Thyroiditis
    1. Nearly identical, except limited to Postpartum Period
  3. Hashimoto's Thyroiditis
    1. Similar, except pathology (Fibrosis, Hurthle Cells)
  4. Grave's Disease
    1. Presents with pretibial edema, Proptosis
  5. Subacute Thyroiditis
    1. Painful Thyroiditis

VI. Labs

  1. Thyroid Function Tests (T4 Free and TSH)
    1. Vary based on phase of illness
  2. Antibodies
    1. Antithyroid Peroxidase Antibody or TPO Antibody (positive in 50%)
    2. Thyroid Stimulating Immunoglobulins absent
      1. Contrast with Grave's Disease

VII. Imaging

  1. Radioiodine Uptake (Thyroid uptake and scan)
    1. Low uptake in hyperthyroid phase (contrast with Grave's Disease)

VIII. Management

  1. Beta Blockers (e.g. Propranolol)
    1. Indicated for Hyperthyroidism symptoms
  2. Levothyroxine
    1. Indicated for symptomatic Hypothyroidism or persistent, chronic Hypothyroidism

IX. Course

  1. Resolves within 12 months (up to 18 months) in 89% of cases
  2. Hypothyroidism persists chronically in 10-20% of cases
  3. Recurrence in 5-10% of cases

X. References

  1. Bindra (2006) Am Fam Physician 73(10):1769-76 [PubMed]
  2. Quintero (2021) Am Fam Physician 104(6): 609-17 [PubMed]
  3. Sweeney (2014) Am Fam Physician 90(6): 389-96 [PubMed]

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Subacute Lymphocytic Thyroiditis." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Topics in Thyroid Disease

advertisement