- Acute thyroiditis – Rare and due to suppurative infection in the thyroid gland. Most common in children and young adults with the presence of a piriform sinus. In the elderly, a long-standing goiter is a risk factor. Patients present with thyroid pain with referral to the ears and throat with a small, tender goiter. Fever, erythema of the thyroid, and dysphagia are common. Labs reveal elevated WBC and C-reactive protein (CRP), normal thyroid stimulating hormone (TSH) with polymorphonuclear leukocytes (PMNs), and bacteria often noted on fine needle aspiration. Treatment includes antibiotics and/or abscess drainage.
- Subacute or de Quervain thyroiditis – Often secondary to viral illness and may be mistaken for viral pharyngitis. Commonly implicated viruses include mumps, influenza, coxsackie, adenoviruses, and echoviruses. Peak incidence is ages 30-50 years with women more often affected than men. Patients typically present with acute upper respiratory illness with fever followed by thyroid tenderness and goiter. There are alterations in thyroid function over the course of the disease, initially with increased T3 and T4 with depressed TSH, followed by decreased T3 and T4 with increased TSH, finally with return to euthyroid state as the disease subsides.
- Silent thyroiditis – Occurs in patients with underlying thyroid disease and presents in a similar manner to subacute thyroiditis with a hyperthyroid phase, followed by a hypothyroid phase, and finally return to euthyroid. This entity is more common in women and often associated with type 1 diabetes mellitus and pregnancy. Erythrocyte sedimentation rate (ESR) values are typically normal and thyroid peroxidase (TPO) antibodies are present.
- Drug-induced thyroiditis – Painless thyroiditis may be seen in patients receiving interleukin 2 (IL-2) and interferon-alpha therapy.
E06.9 – Thyroiditis, unspecified
82119001 – Thyroiditis