Subacute Granulomatous Thyroiditis (de Quervain)



Subacute Granulomatous Thyroiditis (de Quervain)


Lester D. R. Thompson, MD










Multiple follicles are affected by a mixed inflammatory infiltrate, including histiocytes and neutrophils. There is a background of interfollicular fibrosis. This early stage shows the folliculocentric process.






The mixed inflammatory infiltrate shows lymphocytes surrounding a destroyed follicle image, filled with epithelioid histiocytes and multinucleated giant cells image with neutrophils. Fibrosis is also seen.


TERMINOLOGY


Abbreviations



  • Subacute granulomatous thyroiditis (SGT)


Synonyms



  • Subacute thyroiditis


  • Granulomatous thyroiditis


  • de Quervain thyroiditis


  • Painful subacute thyroiditis


  • Postviral thyroiditis


  • Giant cell thyroiditis


  • Subacute nonsuppurative thyroiditis


  • Pseudotuberculous thyroiditis


  • Struma granulomatosa


Definitions



  • Self-limited inflammatory condition characterized by epithelioid histiocytes, multinucleated giant cells, and acute inflammatory cells (at certain times in disease development)



    • Requires clinicopathologic correlation with known systemic disease


    • Granulomatous inflammation can be seen in patients with tuberculosis, fungal infections, sarcoidosis


ETIOLOGY/PATHOGENESIS


Infectious



  • Systemic viral infection most common



    • Common prodromal signs and symptoms


    • Intrathyroidal activated T-cytotoxic cells with interferon γ positive lymphocytes


    • Incidence highest in summer months, coincident with enteroviral infections


    • Associated with mumps, influenza, Coxsackie adenovirus, and measles epidemics


    • However, a significant number of patients do not have viral infection


  • Develops after antiviral therapy, specifically interferon


Inherited



  • Genetic predisposition suggested



    • Increased frequency in patients with HLA-B35 haplotype


Autoimmune



  • Possible autoimmune component, as there are thyroid autoantibodies in a few patients


CLINICAL ISSUES


Epidemiology



  • Incidence



    • Incidence approximately 5 per 100,000 population per year


    • Suggested seasonal increase in spring and summer


  • Age



    • Wide range



      • Peak: 5th decade


    • Rare in children


  • Gender



    • Female > > Male (3.5:1 )


Site



  • Entire gland usually involved



    • May be localized to 1 lobe or a distinct nodule


Presentation



  • Prodrome heralds disease



    • Low-grade fever, myalgias, fatigue, sore throat


  • Painful thyroid gland is most common symptom



    • SGT is most common cause of painful thyroid


    • May radiate to jaw


    • Tender to palpation


    • Some patients may not have pain or tenderness


  • Frequently presents with hyperthyroidism




    • Rarely, may present with thyroid storm


  • Become hypothyroid in ensuing weeks to months


  • Spontaneous return to normal function in most patients within 12 months



    • ˜ 7% have persistent hypothyroidism


  • May have other symptoms, including



    • Dysphagia, arthralgia, tremor, excessive sweating, weight loss


Laboratory Tests



  • Thyroid function varies during disease arc



    • Early phase: May be hyperthyroid due to follicle destruction and release of hormone



      • TSH is suppressed; T4 and T3 are elevated


    • Mid phase: Become hypothyroid after follicles are destroyed


    • Late phase: Regain euthyroid after disease resolution


    • Few patients may have transient elevation of antibodies to thyroglobulin or thyroperoxidase


  • C-reactive protein and erythrocyte sedimentation rate are usually elevated

Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Subacute Granulomatous Thyroiditis (de Quervain)
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