Subacute thyroiditis
Subacute thyroiditis is a long-term thyroiditis characterized by desquamation and degeneration of thyrocytes, which are replaced by connective tissue cells, the presence of giant multinucleated cells and granulomas, as well as an increase in the blood levels of AT to thyroglobulin. The predominant age is 30-40 years. Women get sick 4 times more often. Etiology and pathogenesis. Viruses, presumably infectious parotitis and Coxsackie, penetrate into thyrocytes, cause the formation of atypical proteins with the development of an inflammatory reaction in the subsequent.
Clinical picture
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- Early signs: prodromal events in the form of malaise, upper respiratory symptoms and fever lasting 1-2 weeks. Then the thyroid gland becomes enlarged, becomes dense and painful, the pain radiates to the ears, neck or hands
- Hyperthyroidism can occur due to the release of thyroid hormones from damaged follicles into the bloodstream.
- Pain in the thyroid gland and hyperthyroidism subside after a few weeks or months. Usually, the gland returns to normal size; if the enlarged size persists, chronic thyroiditis should be suspected.
Diagnostics
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- Very low thyroid uptake of radioactive iodine at high serum levels of T4 and T3 due to damage and inability of follicular cells to take up iodine, as well as inhibition of TSH secretion by increased levels of circulating thyroid hormones
- Increased AT titer to thyroglobulin
- The presence of giant multinucleated cells in the puncture biopsy.
Treatment is symptomatic, tk. disease resolves on its own
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- NSAIDs and glucocorticoids (in severe cases) relieve pain and tenderness on palpation
- B-Adrenoblockers to relieve symptoms of hyperthyroidism.
Synonyms
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- De Quervain disease
- De Quervain granulomatous goiter
- De Quervain’s thyroiditis
- Thyroiditis granulomatous giant cell