Thyroiditis
Basics
Description
Painful or painless inflammatory dysfunction of the thyroid gland
- Painful thyroiditis:
- Subacute granulomatous thyroiditis (nonsuppurative thyroiditis, de Quervain thyroiditis, giant cell thyroiditis): self-limited; viral URI prodrome, symptoms and signs of thyroid dysfunction (variable)
- Infectious/suppurative thyroiditis is most commonly associated with Streptococcus pyogenes, Staphylococcus aureus, and Streptococcus pneumoniae but can be due to fungal, mycobacterial, or parasitic infections of the thyroid.
- Radiation-induced thyroiditis: from radioactive iodine therapy (1%) or external irradiation
- Painless thyroiditis
- Hashimoto (autoimmune) thyroiditis (chronic lymphocytic thyroiditis): most common etiology of chronic hypothyroidism; 90% of patients with high-serum antithyroid peroxidase (TPO) antibodies
- Postpartum thyroiditis (PPT): thyrotoxicosis followed by hypothyroidism in the 1st year postpartum or after spontaneous/induced abortion in women who were without clinically evident thyroid disease before pregnancy
- Painless (silent) thyroiditis (subacute lymphocytic thyroiditis): mild hyperthyroidism, small painless goiter, and no Graves ophthalmopathy/pretibial myxedema
- Riedel (fibrous) thyroiditis: rare inflammatory process involving the thyroid and surrounding cervical tissues; associated with various forms of systemic fibrosis; presents as a firm mass in the thyroid commonly associated with compressive symptoms (dyspnea, dysphagia, hoarseness, and aphonia) caused by local infiltration of the advancing fibrotic process with hypocalcemia and hypothyroidism
- Drug-induced thyroiditis: interferon-α, interleukin-2, amiodarone, kinase inhibitors, or lithium
Epidemiology
- Subacute granulomatous thyroiditis: most common cause of thyroid pain; peaks during summer; incidence: 3/100,000/year; female > male (4:1); peak age: 40 to 50 years
- Hashimoto thyroiditis (HT): peak onset 30 to 50 years; can occur in children; female > male (7:1)
- PPT: occurs within 12 months of pregnancy in 1–18% of pregnancies
- Painless (silent) thyroiditis: accounts for 1–5% of cases; female > male (4:1) with peak age 30 to 40 years; common in areas of iodine sufficiency
- Reidel thyroiditis: female > male (4:1); highest prevalence age: 30 to 60 years; rare with estimated incidence of 1.06 cases per 100,000 patients
Etiology and Pathophysiology
- Subacute granulomatous thyroiditis: probably viral; can be associated with COVID-19 infection; the mechanism of thyroid injury can be due to direct destruction of thyroid tissue, as well as indirect immune-mediated responses and medicines used to treat COVID-19 (1).
- Hashimoto disease: Antithyroid antibodies may be produced in response to an environmental antigen and cross-react with thyroid proteins (molecular mimicry). Precipitating factors include infection, stress, sex steroids, pregnancy, iodine intake, and radiation exposure.
- PPT: autoimmunity-induced discharge of preformed hormone from the thyroid
- Painless (silent) thyroiditis: autoimmune
- Riedel (fibrous) thyroiditis: rare inflammatory process involving the thyroid and surrounding cervical tissues; associated with various forms of systemic fibrosis
Genetics
Autoimmune thyroiditis is associated with the CT60 polymorphism of cytotoxic T-cell lymphocyte–associated antigen 4; also associated with HLA-DR4, HLA-DR5, and HLA-DR6 in whites
Risk Factors
- Subacute granulomatous thyroiditis: recent viral respiratory infection, such as COVID-19 infection, or HLA-B35
- Hashimoto disease: family/personal history of thyroid/autoimmune disease, high iodine intake, cigarette smoking, selenium deficiency
General Prevention
Insufficient evidence to justify the use of vitamin D or selenium supplementation
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Citation
Domino, Frank J., et al., editors. "Thyroiditis." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116601/all/Thyroiditis.
Thyroiditis. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116601/all/Thyroiditis. Accessed November 7, 2024.
Thyroiditis. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116601/all/Thyroiditis
Thyroiditis [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 November 07]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116601/all/Thyroiditis.
* Article titles in AMA citation format should be in sentence-case
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