De Quervain's thyroiditis overview
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De Quervain's thyroiditis Microchapters |
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Differentiating De Quervain's thyroiditis from other Diseases |
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Diagnosis |
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Treatment |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Furqan M M. M.B.B.S[2]
Overview
De Quervain's thyroiditis usually occurs in women between 30 and 50 years of age. It is a member of the group of thyroiditis conditions known as resolving thyroiditis.
Historical Perspective
In 1895, Mygind first described de Quervain's thyroiditis. In 1904, Fritz de Quervain differentiated this disease from other forms of thyroiditis on the basis of the pathological findings.
Classification
De Quervain's thyroiditis can be classified according to the development of symptoms into the prodromal stage, hyperthyroid stage, euthyroid stage, and hypothyroid stage.
Pathophysiology
The exact pathogenesis of de Quervain's thyroiditis is unclear. It is proposed that cytotoxic T cell recognition of viral and cell antigens presentation in a complex leads to the thyroid follicular cell damage which is responsible for the pathogenesis of de Quervain's thyroiditis. De Quervain's thyroiditis is usually preceded by a viral prodrome and also have a genetic predisposition. HLA B35 and HLA B15/62 are associated with de Quervain's thyroiditis.
Causes
De Quervain's thyroiditis may be caused by viruses such as mumps, adenovirus, Epstein–Barr virus, coxsackievirus, cytomegalovirus, influenza, echovirus, and enterovirus. Genetic factors also predispose an individual towards de Quervain's thyroiditis.
Differentiating De Quervain's thyroiditis from other Conditions
De Quervain's thyroiditis must be differentiated from other causes of thyroiditis, such as Hashimoto's thyroiditis, Riedel's thyroiditis, and suppurative thyroiditis.
Epidemiology and Demographics
De Quervain's thyroiditis is particularly common in middle aged women, Asians, and Whites. Annually, there are around 22 per 100,000 individuals worldwide.
Risk Factors
Common risk factors in the development of de Quervain's thyroiditis are viral illness, family history, and female gender.
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Patients will experience a hyperthyroid period as the cellular lining of colloid spaces fails, allowing abundant colloid into the circulation, with neck pain and fever. Patients typically then become hypothyroid as the pituitary reduces TSH production and the inappropriately released colloid is depleted before resolving to euthyroid. The symptoms are those of hyperthyroidism and hypothyroidism. In addition, patients may suffer from painful dysphagia. There are multi-nucleated giant cells on histology.
Laboratory Findings
Electrocardiogram
Chest X Ray
Echocardiography or Ultrasound
Other Imaging Findings
Treatment
Medical Therapy
Treatment is NSAID.
Corticosteroids may be of help in refractory cases.
Surgery
Primary prevention
Secondary Prevention
References
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