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SUBACUTE THYROIDITIS - DE QUERVAINS

What is Subacute Thyroiditis ?

The thyroid gland is found low in the neck and is shaped like a butterfly. Its hormones, thyroxine (T4) and triiodothyronine (T3), are normally released into the blood circulation. The hormones control the speed of the body's functions (metabolism). In subacute thyroiditis, inflammation of the thyroid gland results in the release of large amounts of both hormones into the blood circulation. The thyroid itself may swell, producing an unusual type of sore throat. Pain is often felt at the side of the neck and into the ear: the throat is rarely red. There may be a slight fever. Because of the high thyroid hormone levels, the heart rate increases causing palpitations. Increased nerve activity causes sweating, diarrhoea and a feeling of anxiety, together with trembling of the hands. Excessive production of energy in the body causes weight loss and a feeling of heat. The condition sometimes appears to follow a virus flu-like illness, and the sore throat may be mistaken for the pharyngitis seen in the usual virus conditions. Sometimes there is no pain at all: only the effects of the thyroid hormones.

How does Subacute Thyroiditis occur ?

Viruses are probably responsible for entering the cells of the thyroid and damaging them. As a result, increased amounts of hormones leak out into the blood circulation. Thyroid swelling and pain are due to enlargement of the damaged, inflamed thyroid cells, and this will subside to normal as the cells recover.

Why does Subacute Thyroiditis occur ?

It is not certain why viruses attack the thyroid. It does not indicate any particular proneness of the thyroid to develop later problems.

Treatment involved for Subacute Thyroiditis

Like all virus infections, the condition always tends to settle by itself. Sometimes the pain is quite troublesome. Regular doses of aspirin work quite well. More severe cases are mostly treated with cortisone-like drugs (steroids) which suppress inflammation. These are begun in high dosage, but reduced only slowly over a period of weeks, to avoid a risk of relapse. Beta-blockers (e.g. propranolol) are often used to block the nerve activity which is stimulated by the high hormone levels. This helps to correct the sweating, palpitations and the feelings of anxiety. Your doctor may continue them for 2 to 3 months. The antithyroid drugs used in other types of overactive thyroid are ineffective in this condition.

During treatment for Subacute Thyroiditis

A little time off work is probably a good idea in the early stages. Symptoms gradually settle with treatment, and the doctor's measurements of thyroid hormone levels in the blood will show a gradual fall towards normal. Aspirin may upset the stomach in the doses used, producing indigestion. If so, the doctor needs to know. Steroids can also do this, as well as causing weight gain. Steroids occasionally cause diabetes, so the doctor will check your blood pressure and also regularly check urine tests for sugar.

After Treatment

Two to three months after the start of the illness, everything should feel back to normal. However, in 10% to 30% of cases, the damaged thyroid cells recover much more slowly (or not at all) and produce less thyroid hormone than usual. This condition is called hypothyroidism. It can easily be confirmed with blood tests. The symptoms are tiredness, slowness of thought and weight gain. These are readily treated with thyroid hormone tablets (usually thyroxine). They need to be taken for up to 6 months, and very rarely for the rest of your life. In these rare cases, blood tests need to be taken at regular intervals to check whether the dose is correct. The thyroid tablets should never be stopped unless directly advised by your doctor.

If Subacute Thyroiditis is left untreated

There would be considerable discomfort, particularly from the thyroid swelling itself. The release of the hormones can also produce quite prolonged disability. However, eventually all cases improve even without treatment. Failure to treat the late underactive thyroid state could produce tiredness, depression and very poor long-term health in some instances.

Effects on the family of Subacute Thyroiditis

The condition is not infectious, and there is no inherited family tendency to get the same condition. Friends may need to put up with the patient's general irritability during the first few weeks!