De Quervain's Thyroiditis
Description
De Quervain’s thyroiditis is an inflammation of the thyroid gland that may be caused by a viral infection. Named after the swiss surgeon Fritz de Quervain’s, the condition is also called subacute thyroiditis or giant cell thyroiditis. It can affect the production of hormones from the thyroid gland resulting in either overproduction (hyperthyroidism) or underproduction (hypothyroidism) causing various symptoms. De Quervain’s thyroiditis is usually a painful condition that resolves on its own but requires treatment to ease the symptoms. It mostly affects middle-aged women.
Causes
The cause for De Quervain’s thyroiditis is not exactly known but it is mostly attributed to viruses that cause measles and mumps as well as coxsackievirus and adenovirus. People who do get the condition often have a history of upper respiratory tract infection in the previous two months.
Impact
De Quervain’s thyroiditis can cause pain, fever, fatigue and various other symptoms that can affect your normal routine and quality of life.
Anatomy
The thyroid gland is a butterfly-shaped gland in front of the wind pipe in the lower neck. It is located between the Adam’s apple and sternum and produces hormones that regulate metabolism. Metabolism is the rate at which your body carries out various processes such as converting food into energy. A viral infection can cause inflammation of the gland and affect the production of hormones.
Symptoms
De Quervain’s thyroiditis usually passes through 4 stages. In the acute phase, there is an overproduction of hormones by the thyroid called hyperthyroidism. This stage usually lasts 3-6 weeks and patients typically experience neck pain, tenderness, thyroid enlargement, sweating, fever, heat intolerance, frequent bowel movements and nervousness. This is followed by a euthyroid stage lasting 1-3 weeks during which the thyroid appears to function normally, and no symptoms are present. A hypothyroid state then develops characterized by fatigue, dry skin, swollen eyes, intolerance to cold and constipation. This stage can last several weeks or months. During the final stage, the thyroid gradually recovers its normal function and symptoms diminish.
Diagnosis
Your doctor will review your history and make a careful examination to diagnose De Quervain’s thyroiditis. This helps distinguish it from other common conditions that affect the thyroid for which medications such as anti-thyroid or hormone replacement therapy are necessary. De Quervain’s thyroiditis resolves on its own so no specific treatment is required. Examination involves inspection and palpation of the thyroid gland. A blood test is performed to check the level of hormones. Hormonal levels vary according to the stage of the disease. A biopsy or a sample of tissue may be obtained from the thyroid for laboratory evaluation. In cases of de Quervain’s, large cells with multiple nuclei are evident for which the condition is also referred to as giant cell thyroiditis.
Untreated
Without treatment to control the symptoms of De Quervain’s thyroiditis, one can experience great discomfort and loss of function for weeks or months.
Treatments
De Quervain’s thyroiditis is normally treated with NSAIDs or steroids to control inflammation and pain. in the early stages, the symptoms of hyperthyroidism are controlled with beta blockers which reduce blood pressure and pulse rate. In the late stages of the disease, temporary hormone replacement therapy is recommended to manage symptoms of hypothyroidism until the condition resolves.
Down-time, lifestyle or off-work duration
Complete recovery usually takes 12-18 months.
Prognosis
Prognosis is good and the condition does not usually recur. Approximately 5-10% of patients retain a degree of hypothyroidism permanently.
