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Clinical Manifestations of Thyroiditis Subtypes

Thyroiditis refers to a group of inflammatory diseases affecting the thyroid gland. With the help of historical information, a physical examination and diagnostic tests, physicians can classify the type of thyroiditis and initiate appropriate treatment.

 Subtype Etiology Neck pain RAIU TSH T4 Thyroid autoantibodies
 Chronic lymphocytic (Hashimoto's disease)  Autoimmune No Variable Variable Variable Present
 Subacute granulomatous Viral  Yes Decreased Decreased Increased Absent
 Subacute lymphocytic Autoimmune No Decreased Decreased Increased Present
 Microbial inflammatory Bacterial, fungal, parasitic Yes Variable  Normal  Normal Absent
 Hashitoxicosis Autoimmune No Decreased  Decreased Increased Present
 Invasive fibrous Unknown No  Variable Normal Normal  Variable
RAIU = radioactive iodine uptake; TSH = thyroid-stimulating hormone; T4 = thyroxine.

Thyroiditis is a group of inflammatory thyroid disorders. Patients with chronic lymphocytic thyroiditis (also referred to as Hashimoto's thyroiditis) present with hypothyroidism, goiter, or both. Measurement of serum thyroid autoantibodies and thyroglobulin confirms the diagnosis. Subacute granulomatous thyroiditis (sometimes referred to as de Quervain's disease) is a self-limited but painful disorder of the thyroid. Physical examination, elevated erythrocyte sedimentation rate, elevated thyroglobulin level and depressed radioactive iodine uptake (RAIU) confirm the diagnosis. Subacute lymphocytic thyroiditis (silent thyroiditis) is considered autoimmune in origin and commonly occurs in the postpartum period. Symptoms of hyperthyroidism and depressed RAIU predominate. Acute (suppurative) thyroiditis is a rare, infectious thyroid disorder caused by bacteria and other microbes. The rare, invasive fibrous thyroiditis (Riedel's thyroiditis) presents with a slowly enlarging anterior neck mass that is sometimes confused with a malignancy.

  1. Slatosky J, Shipton B, Wahba H. Thyroiditis: differential diagnosis and management. Am Fam Physician. 2000 Feb 15;61(4):1047-52 [Medline]
  2. Nayak B, Hodak SP. Hyperthyroidism. Endocrinol Metab Clin North Am. 2007 Sep;36(3):617-56 [Medline]

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