Thyroiditis and Subacute Thyroid Disease

Question 1

Subacute thyroiditis is most common in who?

Answer 1

Females, aged 20-50

Question 2

What is the most common trigger of subacute thyroiditis? What symptoms may this cause?

Answer 2

Viral infection- painful neck, fever

Question 3

What scan can be performed to help diagnose subacute thyroiditis?

Answer 3

Scintigraphy scan

Question 4

What will a scintigraphy scan show in subacute thyroiditis?

Answer 4

Low uptake throughout

Question 5

What is usually the origin of DeQuervain’s thyroiditis?

Answer 5

Viral infection

Question 6

How does DeQuervain’s thyroiditis usually present? What may precede it?

Answer 6

Painful goitre with a preceding upper respiratory tract infection

Question 7

What type of inflammation is involved in DeQuervain’s thyroiditis?

Answer 7

Granulomatous

Question 8

How would you describe the goitre in subacute lymphocytic thyroiditis?

Answer 8

Small and painless

Question 9

What are the different phases in subacute lymphocytic thyroiditis?

Answer 9

Hyperthyroid, euthyroid, hypothyroid, euthyroid

Question 10

How is subacute lymphocytic thyroiditis diagnosed?

Answer 10

Iodine uptake scan

Question 11

What is a variant of subacute lymphocytic thyroiditis?

Answer 11

Post-partum thyroiditis

Question 12

Subacute lymphocytic thyroiditis (and post-partum thyroiditis) and considered subtypes of precursors of what?

Answer 12

Hashimoto’s thyroiditis

Question 13

Which is autoimmune- DeQuervain’s thyroiditis or subacute lymphocytic thyroiditis?

Answer 13

Subacute lymphocytic thyroiditis

Question 14

Amiodarone inhibits what? This has what effect on TFTs?

Answer 14

DI01- Increased T4, Decreased T3, Normal TSH

Question 15

TFTs are abnormal in what % of patients on amiodarone?

Answer 15

50%

Question 16

Is it more common for patients to be hypo or hyperthyroid on amiodarone?

Answer 16

Hypothyroid

Question 17

What is the relation between amiodarone causing hypothyroid and iodine?

Answer 17

Amiodarone causes hypothyroid in areas which are iodine rich

Question 18

What is the relation between amiodarone causing hyperthyroid and iodine?

Answer 18

Amiodarone causes hyperthyroid in areas which are iodine deficient

Question 19

How is subacute thyroid disease described?

Answer 19

Abnormal TSH with normal thyroid hormone levels

Question 20

What will TFTs show in subclinical hypothyroidism?

Answer 20

• Increased TSH with normal T3/4

Question 21

Is there a risk of subclinical thyroid disease becoming overt?

Answer 21

Yes

Question 22

What increases the risk of progression from subclinical hypothyroidism to hypothyroidism?

Answer 22

If the patient is highly anti-TPO antibody positive

Question 23

When should subclinical hypothyroid be treated?

Answer 23

If TSH > 10 or the patient is pregnant

Question 24

What will TFTs show in subclinical hyperthyroidism?

Answer 24

• Decreased TSH and normal T3/4

Question 25

Subclinical hyperthyroidism is most likely to progress to what?

Answer 25

Toxic multi nodular goitre

Question 26

There is often an association between subclinical hyperthyroidism and what other two diseases?

Answer 26

AF and osteoporosis

Question 27

When should subclinical hyperthyroid be treated?

Answer 27

If AF or osteoporosis are present, or if TSH < 0.1

Question 28

When is sick euthyroid syndrome encountered? Why?

Answer 28

Sick, hospitalised patients because their current illness has interfered with the HPT axis

Question 29

What will happen to TSH levels during sick euthyroid syndrome?

Answer 29

They will be suppressed initially and then rise during recovery

Question 30

Should TFTs be performed in acutely unwell patients?

Answer 30

No (not unless there is clinical suspicion of an underlying thyroid disease)