Thyroiditis is inflammation of the thyroid gland, caused by a viral illness (subacute), autoimmunity (Hashimoto, postpartum) or drugs such as amiodarone. Many forms first leak stored hormone and cause a short overactive phase, which may be followed by an underactive phase before recovery.
Key symptoms
- Neck pain spreading to the jaw or ear, often after a viral illness (subacute type)
- Palpitations, anxiety, heat intolerance and weight loss in the early phase
- Fatigue, cold intolerance, weight gain and constipation in the later phase
- Fever and malaise in the painful form
- Painless form after childbirth or with no clear trigger
What you find on exam
- Tender, firm thyroid in subacute thyroiditis; nontender in painless forms
- Fast pulse, tremor and warm moist skin in the toxic phase
- Slow pulse, dry skin and slow reflex relaxation in the hypothyroid phase
- No eye signs of Graves disease such as bulging eyes
Tests
- TSH and free T4; T3 if needed
- ESR or CRP, high in subacute thyroiditis
- Low radioiodine uptake, which separates it from Graves disease
- Thyroid antibodies (TPO) for autoimmune causes; ultrasound if a nodule is felt
Treatment basics
- Beta blocker such as propranolol for palpitations and tremor
- NSAID such as ibuprofen for pain; prednisone if severe
- No antithyroid drugs: the gland is leaking hormone, not making more
- Levothyroxine for a symptomatic or lasting hypothyroid phase
- Recheck thyroid tests every 4 to 8 weeks until stable
Red flags
- Very fast heart rate, high fever or confusion (possible thyroid storm)
- Red, hot, fluctuant neck swelling with high fever (suppurative thyroiditis)
- Fast-growing neck mass with trouble breathing or swallowing
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.