Granulomatous thyroiditis

Granulomatous Thyroiditis, also known as subacute thyroiditis or De Quervain's thyroiditis, is a thyroid gland disorder characterized by inflammation. It is a relatively rare condition that often results in thyroid pain and hyperthyroidism, followed by hypothyroidism in some cases. The disease is named after the Swiss surgeon Fritz de Quervain, who first described it in the early 20th century.

Etiology and Pathogenesis

The exact cause of Granulomatous Thyroiditis remains unclear, but it is believed to be related to a viral infection or a post-viral inflammatory response. The condition is often preceded by an upper respiratory tract infection. It is thought that the inflammation results from the body's immune response attacking the thyroid gland, leading to the characteristic granulomatous inflammation.

Clinical Presentation

Patients with Granulomatous Thyroiditis typically present with a sudden onset of pain in the neck, which may radiate to the jaw or ears. Other common symptoms include fever, malaise, and symptoms of hyperthyroidism such as weight loss, nervousness, and palpitations. As the disease progresses, patients may experience symptoms of hypothyroidism, including fatigue, weight gain, and cold intolerance.

Diagnosis

The diagnosis of Granulomatous Thyroiditis is primarily based on clinical presentation and laboratory findings. Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels are indicative of inflammation. Thyroid function tests may show transient hyperthyroidism followed by hypothyroidism. Ultrasound of the thyroid may reveal characteristic findings, and fine-needle aspiration biopsy can confirm the diagnosis by demonstrating granulomatous inflammation.

Treatment

Treatment of Granulomatous Thyroiditis is mainly symptomatic. High doses of non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids may be used to reduce inflammation and pain. Thyroid hormone replacement therapy may be necessary for patients who develop hypothyroidism. The condition usually resolves within a few months, but thyroid function should be monitored as some patients may develop permanent hypothyroidism.

Prognosis

The prognosis for Granulomatous Thyroiditis is generally good, with most patients recovering completely within 12 to 18 months. However, a small percentage of patients may develop long-term thyroid dysfunction requiring ongoing management.