Subsharp thyroiditis (also known as De Quervain's granulomatous thyroiditis) is a disease that is not well understood by some doctors. Therefore, it is possible to get an incorrect or inaccurate diagnosis, says Dr. Krasimir Khajilazov. He is a specialist in endocrinology and head of the department of endocrinology and metabolic diseases at the Internal Medicine Clinic at the Second MBAL Hospital in Sofia.
What is subacute thyroiditis - De Quervain's thyroiditis?
Subacute thyroiditis describes a condition associated with inflammation of the thyroid gland. It is usually triggered by an upper respiratory infection. Mumps virus, influenza virus, and other respiratory viruses have been found to cause subacute thyroiditis. In many cases, however, it just subsides.
The most important characteristic of subacute thyroiditis is the gradual or sudden onset of pain in the area of the thyroid gland. A painful enlargement of the thyroid gland can last for weeks or months. Sometimes there may be a high fever. Some patients complain of a hoarse voice or difficulty swallowing.
In subacute thyroiditis, it can be observed as hyperfunction, as well hypofunction of the thyroid gland. Symptoms of excess thyroid hormones (hyperthyroidism) such as nervousness, rapid heart rate, and heat intolerance may be present early in the illness. Later, symptoms of too little thyroid hormone (hypothyroidism) may appear, such as fatigue, constipation or cold intolerance. Eventually, thyroid function returns to normal.
Subacute thyroiditis occurs most often in middle-aged women with recent symptoms of a viral respiratory infection.
Symptoms of thyroiditis usually include:
- pain in the front of the neck
- tenderness with light pressure on the thyroid gland (palpation)
- temperature
- weakness
- fatigue
Additional symptoms may include:
- nervousness
- intolerance to heat
- weight loss
- sweating
- diarrhea
- tremor
- heartbeat
Laboratory tests in the early phase of the disease may show:
- High serum thyroglobulin
- Low absorption of radioactive iodine
- Low serum thyroid stimulating hormone (TSH).
- High serum level of free T4 (thyroid hormone, thyroxine).
- Elevated erythrocyte sedimentation rate (ESR)
- Laboratory tests in the later phase of the disease may show:
- High serum TSH level
- Low serum free T4
Antithyroid antibodies are either undetectable or present at low levels.
Treatment for thyroiditis includes anti-inflammatory drugs
The goal of treatment is to reduce pain and inflammation and treat any hyperthyroidism, if present. Anti-inflammatory drugs such as aspirin or ibuprofen are used to control pain in mild cases of subacute thyroiditis.
More serious cases may require temporary treatment with steroids (eg, prednisone) to control inflammation. Symptoms of hyperthyroidism are treated with a class of drugs called beta-blockers (eg, propranolol, atenolol).
General practitioners, to whom patients usually go first, should be aware that only with this thyroid disease can pain on pressure and swallowing be reported. The pain can radiate to the ears and lower jaw, reminds Dr. Hadjilazov.
He points out that an ultrasound of the thyroid gland shows specific changes that are not typical for Hashimoto's and Basedo's disease. If the body deals with the provocateur (viral infection), the inflammation of the thyroid gland can calm down and be cured.
What other causes can there be for thyroid-related hormone imbalance?
The thyroid gland produces hormones vital for a number of processes in the body. These are the hormones FT3 (triiodothyronine) and FT4 (thyroxine). In the broader sense, thyroid status is also associated with the hormone TSH, which is produced by the pituitary gland. However, its level is directly related to the work of the thyroid gland.
If a hormonal imbalance occurs, an increase in TSH is usually found with normal values of FT3 and FT4. Then we are talking about a subclinical form of hypothyroidism. It is usually due to an autoimmune process - Hashimoto's thyroiditis.
Unfortunately, at this stage, hormonal imbalance does not have any tangible symptoms. You may eventually feel tired more easily. Typical symptoms come only when a typical clinical form of hypothyroidism develops. Laboratory values show markedly elevated TSH and FT3 and FT4 are low.
Most patients are women, and they are also worried about the other symptoms:
- fluid retention;
- slowing of metabolism;
- inexplicable weight gain (it's actually more body swelling);
- slight increase in lipids.
Slow reactions, sluggishness, memory impairment, cold skin, hair loss, menstrual disorder in women, etc. are less common. The clinical form of hypothyroidism is actually much rarer than the subclinical (milder) form. Some patients seek Dr. Hadjilazov because they have problems conceiving. They have no symptoms.
The relationship between thyroid disease and pregnancy
An elevated TSH level, even if only slightly above normal, may be related to the cyclic, pulsatile release of follicle-stimulating hormone (FSH); luteinizing hormone (LH), prolactin (Prol). In this way, it affects the chances of getting pregnant and a successful pregnancy. It also affects the development of the fetus.
It is a reasonable question that patients ask: Should treatment be given?
“Usually, TSH most often rises on its own. Hormonal imbalance is thought to be due to the increased level of MAT and TAT antibodies. TSH may rise because something is not done by otherwise normal serum levels of FT3 and FT4. Specific processes related to metabolism, heart, and nervous activity are affected. The pituitary receives information that what FT3 and FT4 are meant to do is not happening despite their normal levels. It is possible that there is a defect in their structure, not in their number," says Dr. Hadjilazov. In addition, a directly proportional relationship between the increase in the number of MAT and TAT antibodies and the increase in TSH was not established.
According to the Bulgarian Society of Endocrinology, when a patient has positive MAT and TAT and TSH is above 2.5, it is recommended to take the hormone levothyroxine, to lower the TSH level.
When these antibodies are not elevated, it is recommended that 2.5 is not a 100 percent criterion and the upper limit is 4-4.2. Most hypertension specialists, and we endocrinologists, would be more comfortable with TSH below 2.5, especially in young patients, as most screening studies have shown this number. In no case, a woman will not burden her body if she takes FT4 in order to reduce TSH, considering that this is the most harmless hormone and especially if pregnancy and/or its normal course and development of the fetus are aimed!
Author: Ina Dimitrova
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