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Subacute thyroiditis

Kenneth D Burman, MD
Section Editor
Douglas S Ross, MD
Deputy Editor
Jean E Mulder, MD


Most thyroidologists use the term subacute thyroiditis to apply specifically to subacute granulomatous thyroiditis. Other names for this disorder are subacute nonsuppurative thyroiditis, giant cell thyroiditis, painful thyroiditis, and de Quervain's thyroiditis. It is a relatively uncommon cause of hyperthyroidism and affects women more often than men (3 to 5:1) [1].

Subacute thyroiditis (subacute granulomatous thyroiditis) is characterized by neck pain or discomfort, a tender diffuse goiter, and a predictable course of thyroid function evolution. Hyperthyroidism is typically the presentation followed by euthyroidism, hypothyroidism, and ultimately restoration of normal thyroid function (figure 1).

The diagnosis and management of subacute thyroiditis will be provided here. Other types of thyroiditis are discussed separately. (See "Overview of thyroiditis".)


The best available incidence data for subacute thyroiditis comes from the Rochester Epidemiology Project in Olmsted county, Minnesota [2,3]. Between 1970 and 1997, 94 patients with subacute thyroiditis were identified. They report an incidence of 12.1 cases per 100,000/year with a higher incidence in females than in males (19.1 and 4.1 per 100,000/year, respectively). It is most common in young adulthood (24 per 100,000/year) and middle age (35 per 100,000/year), and decreases with increasing age.


Subacute thyroiditis is presumed to be caused by a viral infection or a postviral inflammatory process. Many patients have a history of an upper respiratory infection prior to the onset of thyroiditis (typically two to eight weeks beforehand). The disease was thought to have a seasonal incidence (higher in summer) [4], and clusters of cases have been reported in association with Coxsackievirus, mumps, measles, adenovirus, and other viral infections [1,5]. However, in other series, there was a relatively comparable distribution of presentation throughout the year [2,6]. Serial studies of viral antibody titers have implicated many of the same viruses, but the changes could equally be attributed to nonspecific anamnestic responses [7]. Viral inclusion bodies are not seen in thyroid tissue.

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Literature review current through: Nov 2017. | This topic last updated: Feb 02, 2016.
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  1. Lazarus JH. Silent thyroiditis and subacute thyroiditis. In: The Thyroid: A Fundamental and Clinical Text, 7th Ed, Braverman LE, Utiger RD (Eds), Lippincott Williams & Wilkins, Philadelphia 1996. p.577.
  2. Fatourechi V, Aniszewski JP, Fatourechi GZ, et al. Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted County, Minnesota, study. J Clin Endocrinol Metab 2003; 88:2100.
  3. Golden SH, Robinson KA, Saldanha I, et al. Clinical review: Prevalence and incidence of endocrine and metabolic disorders in the United States: a comprehensive review. J Clin Endocrinol Metab 2009; 94:1853.
  4. Martino E, Buratti L, Bartalena L, et al. High prevalence of subacute thyroiditis during summer season in Italy. J Endocrinol Invest 1987; 10:321.
  5. Desailloud R, Hober D. Viruses and thyroiditis: an update. Virol J 2009; 6:5.
  6. Benbassat CA, Olchovsky D, Tsvetov G, Shimon I. Subacute thyroiditis: clinical characteristics and treatment outcome in fifty-six consecutive patients diagnosed between 1999 and 2005. J Endocrinol Invest 2007; 30:631.
  7. Volpé R, Row VV, Ezrin C. Circulating viral and thyroid antibodies in subacute thyroiditis. J Clin Endocrinol Metab 1967; 27:1275.
  8. Ohsako N, Tamai H, Sudo T, et al. Clinical characteristics of subacute thyroiditis classified according to human leukocyte antigen typing. J Clin Endocrinol Metab 1995; 80:3653.
  9. Nishihara E, Ohye H, Amino N, et al. Clinical characteristics of 852 patients with subacute thyroiditis before treatment. Intern Med 2008; 47:725.
  10. Sherman SI, Ladenson PW. Subacute thyroiditis causing thyroid storm. Thyroid 2007; 17:283.
  11. Alper AT, Hasdemir H, Akyol A, Cakmak N. Incessant ventricular tachycardia due to subacute thyroiditis. Int J Cardiol 2007; 116:e22.
  12. Weihl AC, Daniels GH, Ridgway EC, Maloof F. Thyroid function tests during the early phase of subacute thyroiditis. J Clin Endocrinol Metab 1977; 44:1107.
  13. Pearce EN, Bogazzi F, Martino E, et al. The prevalence of elevated serum C-reactive protein levels in inflammatory and noninflammatory thyroid disease. Thyroid 2003; 13:643.
  14. Matsumoto Y, Amino N, Kubota S, et al. Serial changes in liver function tests in patients with subacute thyroiditis. Thyroid 2008; 18:815.
  15. Park SY, Kim EK, Kim MJ, et al. Ultrasonographic characteristics of subacute granulomatous thyroiditis. Korean J Radiol 2006; 7:229.
  16. Hiromatsu Y, Ishibashi M, Miyake I, et al. Color Doppler ultrasonography in patients with subacute thyroiditis. Thyroid 1999; 9:1189.
  17. Ruchala M, Szczepanek E, Sowinski J. Sonoelastography in de Quervain thyroiditis. J Clin Endocrinol Metab 2011; 96:289.
  18. Nikolai TF, Coombs GJ, McKenzie AK. Lymphocytic thyroiditis with spontaneously resolving hyperthyroidism and subacute thyroiditis. Long-term follow-up. Arch Intern Med 1981; 141:1455.
  19. Brander A. Ultrasound appearances in de Quervain's subacute thyroiditis with long-term follow-up. J Intern Med 1992; 232:321.
  20. Omür O, Daglýöz G, Akarca U, Ozcan Z. Subacute thyroiditis during interferon therapy for chronic hepatitis B infection. Clin Nucl Med 2003; 28:864.
  21. Kon YC, DeGroot LJ. Painful Hashimoto's thyroiditis as an indication for thyroidectomy: clinical characteristics and outcome in seven patients. J Clin Endocrinol Metab 2003; 88:2667.
  22. Yang YS, Wu MZ, Cheng AL, Chang TC. Primary thyroid lymphoma mimicking subacute thyroiditis. Acta Cytol 2006; 50:710.
  23. Cunha BA, Chak A, Strollo S. Fever of unknown origin (FUO): de Quervain's subacute thyroiditis with highly elevated ferritin levels mimicking temporal arteritis (TA). Heart Lung 2010; 39:73.
  24. Yamamoto M, Saito S, Sakurada T, et al. Effect of prednisolone and salicylate on serum thyroglobulin level in patients with subacute thyroiditis. Clin Endocrinol (Oxf) 1987; 27:339.