Most common cause of a painful thyroid gland. It is
caused by transient nonbacterial inflammation. Hyperthyroidism often occurs
initially and can be followed by hypothyroidism. (Table Q-1)
++ Table Graphic Jump Location Table Q-1 Characteristic Course of de Quervain Thyroiditis ||Download (.pdf)
Table Q-1 Characteristic Course of de Quervain Thyroiditis
Granulomatous Giant Cell Thyroiditis; De Quervain
Subacute Struma; Quervain Syndrome; Subacute Painful Thyroiditis.
An acquired disease that was first described by Fritz de
Quervain, (1868-1940), a Swiss surgeon, in 1904.
Five percent of all patients with thyroid pathology.
Peak incidence in the fourth and fifth decade of life; sex ratio
female:male 3.5:1. Most common during summer and fall. High incidence of
Presumably caused by a viral infection or postviral
inflammatory response. A proposed mechanism is that a viral antigen binds to
HLA-B35 molecules and that the complex activates cytotoxic T lymphocytes
that damage thyroid follicular cells because of their similarity with the
infection-related antigen. Destruction of follicular epithelium involves
the release of thyroid-binding globulin into blood. T3 and T4 concentration in
serum is increased and thyroid-stimulating hormone secretion is suppressed.
The thyroid follicles then regenerate and thyroid hormone synthesis and
Made on clinical grounds (history, pain, symptom of
hyperthyroidism), ultrasound; thyroid-stimulating hormone and free T4
measurement to determine the cause of hyperthyroidism; serum thyroglobulin (elevated) and
erythrocyte sedimentation rate (>50 mm/h). Thyroid biopsy shows characteristic giant
Features include gradual onset of pain in
the region of the thyroid gland (aggravated with swallowing and head
movement), dysphagia, fever, weakness, and fatigue. Weight loss and diarrhea
may occur. Symptoms of moderate hyperthyroidism (palpitations, tremor, heat
intolerance, nervousness, sweating, skeletal muscle weakening) appear in the
initial phase, usually over 3 to 6 weeks. The initial phase is followed by
the transient asymptomatic phase over the next 1 to 3 weeks. In 50% of
patients, symptoms of hypothyroidism occur in the late phase. It may become
permanent in 5 to 10% of patients. Acute complications (severe
hyperthyroidism, pancreatitis) are exceptional.
Evaluate thyroid function (clinical,
thyroid-stimulating hormone, T3, free T4). Laboratory investigations should include
serum levels of calcium, phosphate and amylase. Preoperative ECG is recommended. Evaluate
tracheal intubation in case of voluminous thyroid (clinical, CT, fiberoptic). Evaluate
hydration in case of diarrhea and fever (clinical, electrolytes).
Nonurgent surgery should be postponed until the
clinical situation has stabilized. Tracheal intubation can (rarely) be difficult.
An adapted anesthetic management for thyroid imbalance may be required. Perioperative invasive
blood pressure and cardiac monitoring are recommended.
Adapt doses to increased metabolism.
Use beta-sympathetic blocker in case of tachycardia. Avoid anticholinergic
Duininck TM, van Heerden JA, Fatourechi V, et al: de ...