Subacute Lymphocytic Thyroiditis

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

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)
  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 (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 11% of cases
  3. Recurrence is uncommon

X. References

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

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Related Studies

Ontology: Subacute lymphocytic thyroiditis (C1306804)

Definition (NCI) Thyroiditis associated with painless enlargement of the thyroid gland. It occurs more frequently in females and is characterized by alterations between hyperthyroidism and hypothyroidism and the eventual return to normal thyroid gland function.
Concepts Disease or Syndrome (T047)
SnomedCT 361126006, 18018005
English Silent Thyroiditis, Subacute Painless Thyroiditis, Subacute lymphocytic thyroiditis, Subacute lymphocytic thyroiditis (disorder), Subacute Lymphocytic Thyroiditis
Spanish tiroiditis linfocítica subaguda (trastorno), tiroiditis linfocítica subaguda
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Thyroid Disease

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