Subacute thyroiditis (also known as De Quervain's thyroiditis and subacute granulomatous thyroiditis) is thought to occur following viral infection and typically presents with hyperthyroidism.

There are typically 4 phases;

• phase 1 (lasts 3-6 weeks): hyperthyroidism, painful goitre, raised ESR
• phase 2 (1-3 weeks): euthyroid
• phase 3 (weeks - months): hypothyroidism
• phase 4: thyroid structure and function goes back to normal

PC

• symptoms of hyperthyroidism
• painful smooth goitre

Investigations

• TFT - Normal TSH, High T4
• thyroid scintigraphy: globally reduced uptake of iodine-131

Management

• usually self-limiting - most patients do not require treatment
• thyroid pain may respond to aspirin or other NSAIDs
• in more severe cases steroids are used, particularly if hypothyroidism develops