Subacute Thyroiditis (de Quervain)

The inflammation of the thyroid gland, also known as Quervain’s thyroiditis or thyroiditis de Quervain after the Swiss Fritz de Quervain (1868-1941), is also an inflammatory tissue disease of the thyroid gland, although it shows a somewhat slower progression of the disease (subacute) and different symptoms than acute thyroiditis. The origin of the disease has not yet been clarified in detail. Subacute thyroiditis begins with local, severe pain in the thyroid gland, which may radiate towards the head and ear or towards the chest as the disease progresses.

Typically, an accompanying general feeling of illness and weakness occurs, which becomes stronger as the severity of the disease increases. Other possible symptoms are headache, fever, muscle pain and clinical signs of hyperthyroidism (restlessness, sweating, sleeping problems, trembling, weight loss). The mechanism of subacute thyroid inflammation is not yet well understood.

However, it often occurs in connection with viral infections, e.g. after virus-induced pneumonia, mumps or the like, and is therefore called parainfectious.The therapy of subacute thyroiditis is purely symptomatic and depends on the severity of the symptoms. In milder forms, the disease is treated with so-called non-steroidal anti-rheumatic drugs (anti-inflammatory drugs) such as ibuprofen. More severe forms of the disease are treated with glucocorticoids (prednisone, cortisone) to combat systemic inflammation.

Here, a high single dose of glucocorticoids is used, which is then reduced by 20% every 1-2 weeks until it is completely eliminated. Here too, overactive thyroid glands may develop during the course of the disease, which is again treated with beta-receptor blockers. Subacute thyroiditis is also usually diagnosed on the basis of the patient’s appearance and symptoms, such as a general feeling of illness with increasing weakness in combination with pain radiating from the thyroid gland towards the head and chest.

To confirm the diagnosis, a blood test is again ordered, which shows an increased blood sedimentation rate and an increase in the C-reactive protein. Compared to an autoimmune thyroid disease, there are no endogenous antibodies against the thyroid cells. In most cases, an additional thyroid sonography is performed, which is spotty and inhomogeneous.

If the diagnosis is still unclear, a fine needle puncture can be used, which shows typical long-neck giant cells, specialized scavenger cells of the body, under the microscope. The duration of subacute thyroiditis is longer than in acute thyroiditis and can last from several months to a year. Depending on how much tissue of the thyroid gland has been destroyed by the inflammation, a temporary hypothyroidism may occur, but it also recedes as the severity of the disease decreases and only in 2-5% of cases does it need to be temporarily treated with medication. Despite the protracted nature of the inflammation, the prognosis is very good and the thyroiditis heals completely.