- Kenneth D Burman, MD
Kenneth D Burman, MD
- Chief, Endocrine Section
- Medstar Washington Hospital Center, Washington, DC
- Professor, Department of Medicine
- Georgetown University Medical Center
Painless thyroiditis is characterized by transient hyperthyroidism, followed sometimes by hypothyroidism, and then recovery (figure 1). Synonyms for this disorder include silent thyroiditis, subacute lymphocytic thyroiditis, and lymphocytic thyroiditis with spontaneously resolving hyperthyroidism. Painless thyroiditis accounts for approximately 0.5 to 5 percent of cases of hyperthyroidism [1,2].
It has many similarities with postpartum thyroiditis but by definition excludes women who have a painless thyroiditis syndrome within one year after a delivery, abortion, or miscarriage. (See "Postpartum thyroiditis".)
The clinical features, diagnosis, and management of painless thyroiditis will be reviewed here. An overview of thyroiditis is discussed separately. (See "Overview of thyroiditis".)
Painless thyroiditis is considered a variant form of chronic autoimmune thyroiditis (Hashimoto's thyroiditis), suggesting that it is part of the spectrum of thyroid autoimmune disease . The two disorders have some pathologic similarities (see 'Pathology' below), and many patients with painless thyroiditis have high serum concentrations of antithyroid peroxidase (TPO) and antithyroglobulin (Tg) antibodies, many have a family history of thyroid autoimmune disease, and some develop overt chronic autoimmune thyroiditis several years later . It affects women more often than men .
Painless thyroiditis is associated with specific human leukocyte antigen (HLA) haplotypes, most often HLA-DR3, findings that suggest an inherited susceptibility . However, the association is considerably weaker than that between HLA-B35 and subacute thyroiditis. (See "Subacute thyroiditis".)
Subscribers log in hereLiterature review current through: Nov 2017. | This topic last updated: Jul 05, 2017.References
- Ross DS. Syndromes of thyrotoxicosis with low radioactive iodine uptake. Endocrinol Metab Clin North Am 1998; 27:169.
- Schwartz F, Bergmann N, Zerahn B, Faber J. Incidence rate of symptomatic painless thyroiditis presenting with thyrotoxicosis in Denmark as evaluated by consecutive thyroid scintigraphies. Scand J Clin Lab Invest 2013; 73:240.
- Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med 2003; 348:2646.
- 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.
- Farid NR, Hawe BS, Walfish PG. Increased frequency of HLA-DR3 and 5 in the syndromes of painless thyroiditis with transient thyrotoxicosis: evidence for an autoimmune aetiology. Clin Endocrinol (Oxf) 1983; 19:699.
- Ogura T, Hirakawa S, Suzuki S, et al. Five patients with painless thyroiditis simultaneously developed in a nursery school. Endocrinol Jpn 1988; 35:225.
- Wilkins M, Moe MM. Acute painless thyroiditis with transient thyrotoxicosis during external beam irradiation to non-Hodgkin's lymphoma of the thyroid gland. Clin Oncol (R Coll Radiol) 2001; 13:311.
- Morita S, Ueda Y, Yokoyama N. Painless thyroiditis induced by the cessation of betamethasone. Intern Med 2001; 40:744.
- Yamakita N, Sakata S, Hayashi H, et al. Case report: silent thyroiditis after adrenalectomy in a patient with Cushing's syndrome. Am J Med Sci 1993; 305:304.
- Miller KK, Daniels GH. Association between lithium use and thyrotoxicosis caused by silent thyroiditis. Clin Endocrinol (Oxf) 2001; 55:501.
- Ozawa Y, Shishiba Y. Recovery from lymphocytic hypophysitis associated with painless thyroiditis: clinical implications of circulating antipituitary antibodies. Acta Endocrinol (Copenh) 1993; 128:493.
- Magaro M, Zoli A, Altomonte L, et al. The association of silent thyroiditis with active systemic lupus erythematosus. Clin Exp Rheumatol 1992; 10:67.
- Nagai K, Sakata S, Takuno H, et al. A case of silent thyroiditis associated with idiopathic thrombocytopenic purpura. Endocrinol Jpn 1988; 35:791.
- Mittra ES, McDougall IR. Recurrent silent thyroiditis: a report of four patients and review of the literature. Thyroid 2007; 17:671.
- Samuels MH. Subacute, silent, and postpartum thyroiditis. Med Clin North Am 2012; 96:223.
- Shigemasa C, Abe K, Taniguchi S, et al. Lower serum free thyroxine (T4) levels in painless thyroiditis compared with Graves' disease despite similar serum total T4 levels. J Clin Endocrinol Metab 1987; 65:359.
- Woolf PD. Transient painless thyroiditis with hyperthyroidism: a variant of lymphocytic thyroiditis? Endocr Rev 1980; 1:411.
- Morita T, Tamai H, Oshima A, et al. The occurrence of thyrotropin binding-inhibiting immunoglobulins and thyroid-stimulating antibodies in patients with silent thyroiditis. J Clin Endocrinol Metab 1990; 71:1051.
- Kamijo K. Study on cutoff value setting for differential diagnosis between Graves' disease and painless thyroiditis using the TRAb (Elecsys TRAb) measurement via the fully automated electrochemiluminescence immunoassay system. Endocr J 2010; 57:895.
- Nikolai TF, Coombs GJ, McKenzie AK, et al. Treatment of lymphocytic thyroiditis with spontaneously resolving hyperthyroidism (silent thyroiditis). Arch Intern Med 1982; 142:2281.
- Ohye H. Recurrent severe painless thyroiditis requiring multiple treatments with radioactive iodine. Thyroid 2008; 18:1231.