Synopsis
Differentiate destructive thyroiditis phenotypes from Graves and bacterial infection, treat pain and adrenergic symptoms appropriately, and anticipate temporary or permanent hypothyroidism.
- Subacute de Quervain thyroiditis is typically painful and tender after a viral-like illness, with raised inflammatory markers and transient destructive thyrotoxicosis.
- Painless or silent thyroiditis is autoimmune and non-tender, while postpartum thyroiditis occurs within the first year after birth and is also usually painless.
- Destructive follicular injury releases stored hormone, so uptake is low and antithyroid medicines are ineffective because synthesis is not the driver.
Key red flags
Toxic appearance, focal unilateral swelling, erythema, fluctuation, marked neutrophilia, immunosuppression or an anatomical fistula raises bacterial infection and warrants emergency ENT assessment.
Investigation priorities
Identify current phase and establish a trend across destructive disease.
Management branches
Anterior neck pain and thyroid tenderness accompany thyroid dysfunction.
- Assess airway, focal swelling, sepsis, immunosuppression and nodule haemorrhage; urgent red flags take priority over an assumed de Quervain diagnosis.
- Measure thyroid profile, CRP or ESR and full blood count, adding cultures and targeted ultrasound when bacterial disease is plausible.
Key medicines
Ibuprofen for subacute thyroid painUse the lowest effective BNF-listed oral anti-inflammatory dose for the shortest duration, commonly 200 to 400 mg up to three times daily with or after food in suitable adults.
Prednisolone for severe subacute thyroiditisUse only an endocrine-agreed oral course and taper from the current local or BNF-informed protocol when severe pain fails appropriate NSAID treatment or NSAIDs are unsuitable.