de Quervain’s thyroiditis is an autoimmune disease<\/p>\n
Pathophysiology<\/strong><\/p>\n 1)<\/strong> inflammation and derangement of thyroid gland function 2)<\/strong> usually preceded by a viral illness (adenovirus, influenza) 3)<\/strong> marked by a hyperthyroid state for 2-3 months, followed by a period of hypothyroidism, followed by (usually) a recovery phase 4)<\/strong> occasionally accompanied by hemorrhage into the thyroid gland.<\/p>\n Signs and Symptoms<\/strong><\/p>\n 1)<\/strong> tremor 2)<\/strong> palpitations 3)<\/strong> nervousness 4)<\/strong> neck pain and tenderness 5)<\/strong> myalgias (muscle pain) 6)<\/strong> fatigue 7)<\/strong> sore throat 8)<\/strong> enlarged gland 9)<\/strong> malaise 10)<\/strong> jaw and ear pain<\/p>\n Characteristic Test Findings<\/strong><\/p>\n Laboratory<\/em> – 1)<\/strong> decreased serum TSH and increased T3 and T4 in hyperthyroid phase 2)<\/strong> increased serum TSH and decreased T3 and T4 in hypothyroid phase 3)<\/strong> increased erythrocyte sedimentation rate (ESR) 4)<\/strong> increased granulocyte count 5)<\/strong> increased IL-6 in hyperthyroid phase 6)<\/strong> increased antibody titers to adenovirus, mumps, and measles Nuclear Medicine<\/em> – 7)<\/strong> low radioiodine uptake<\/p>\n Histology\/Gross Pathology<\/strong><\/p>\n 1)<\/strong> patchy inflammatory infiltrate 2)<\/strong> some follicles with multinucleated giant cells and granulomas with fibrosis 3)<\/strong> thyroid eventually returns to normal if the disease resolves to a euthyroid state<\/p>\n Associated Conditions<\/strong><\/p>\n associated with HLA-B35<\/p>\n Biochemistry<\/strong><\/p>\n thyroid antibodies are negative<\/p>\n Inheritance\/Epidemiology<\/strong><\/p>\n 1)<\/strong> true incidence is unknown 2)<\/strong> more common in women 3)<\/strong> peak age is 30-50 years <\/p>\n Treatment<\/strong><\/p>\n 1)<\/strong> NSAIDs and salicylates (aspirin) are first line treatment 2)<\/strong> 4-8 weeks of steroids if that fails 3)<\/strong> beta blockers for cardiac manifestations of thyrotoxicosis (palpitations and arrhythmias) 4)<\/strong> exogenous T3 and\/or T4 during hypothyroid phase<\/p>\n Tips for USMLE<\/strong><\/p>\n key concept is the four phases of the disease: viral illness, hyperthyroid phase, hypothyroid phase, return to euthyroid state<\/p>\n","protected":false},"excerpt":{"rendered":" de Quervain’s thyroiditis is an autoimmune disease Pathophysiology 1) inflammation and derangement of thyroid gland function 2) usually preceded by a viral illness (adenovirus, influenza) 3) marked by a hyperthyroid state for 2-3 months, followed by a period of hypothyroidism, followed by (usually) a recovery phase 4) occasionally accompanied by hemorrhage into the thyroid gland. […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[63],"tags":[306,308,309,307],"yoast_head":"\n