- 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".)
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