Giant Cell Thyroiditis Research Articles

Immature granulocytes and neutrophil-to-lymphocyte ratio as markers of treatment response in subacute thyroiditis.

Subacute thyroiditis is also known as subacute granulomatous thyroiditis, giant cell thyroiditis, painful thyroiditis, and De Quervain's thyroiditis. Immature granulocytes (IG) and neutrophil-to-lymphocyte ratio (NLR) are new inflammatory markers that are easily detected in routine complete blood count (CBC) tests. The aim of this study was to investigate the role of IG and NLR as markers of treatment response in patients with subacute thyroiditis. The study included 41 patients with subacute thyroiditis treated and monitored in our outpatient clinic between April 2020 and April 2022. From a retrospective review of medical records, we recorded results of IG, NLR, thyroid-stimulating hormone (TSH), free thyroxine (fT4), free triiodothyronine (fT3), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) from blood tests obtained routinely before and after treatment. Overall, 31 (75.6%) patients were women and 10 (21.4%) were men. The median age was 41 years (range 22-68 years). The laboratory tests showed the following median (range) results: IG, 0.03 (0.01-0.08); NLR, 3.6 (1.2-5.2); TSH, 0.02 mIU/L (0.01-3.35 mIU/L); fT4, 2.3 ng/dL (1.0-7.0 ng/dL); fT3, 5.6 pmol/L (2.6-15.2 pmol/L); ESR, 49 mm/h (17.0-87 mm/h); and CRP, 73 mg/dL (3.0-188 mg/dL). Early diagnosis and treatment of subacute thyroiditis is fundamental. In the present study, the new inflammatory markers IG and NLR, measured routinely on CBC tests, decreased significantly after subacute thyroiditis treatment relative to pretreatment values. After treatment, the NLR change correlated with ESR and CRP changes, while the IG change correlated only with CRP change. These findings suggest that the markers IG and NLR may be used to evaluate treatment response in patients with subacute thyroiditis.

ODP515 Severe thyrotoxicosis caused by subacute thyroiditis

Abstract Background Subacute thyroiditis, also named giant cell thyroiditis, painful thyroiditis, and de Quervain's thyroiditis, usually presents with neck pain or discomfort, a tender diffuse goiter and mild or moderate elevation of serum free T4 and T3 levels. Here we report a case of subacute thyroiditis patient presenting with severe thyrotoxicosis. Clinical case: A 27-year-old woman with no significant past medical history presents to the emergency room with palpitations and abnormal EKG with heart rate at 160 beats per minute. She developed a sore throat 3 days prior to the presentation, but she did not have neck pain or fever. She reports a 3-month history of hair loss, headaches and weight gain. Labs showed significantly elevated free T4 greater than 7.7 ng/dl (0.8-1.7) and free T3 level at 20.7 pg/ml (2. 0-4.8), and suppressed TSH less than 0. 01 uIU/ml (0.45-4.5) and normal ESR at 15 mm/hour. Her TPO antibody was greater than 1300 u/ml. Thyroid stimulating immunoglobulin (TSI) and TSH receptor antibody (TRab) were obtained but results were pending when she was discharged from the hospital. She has no typical clinical features of subacute thyroiditis with normal ESR and her free T3 and free T4 levels were significantly elevated. She was discharged on Methimazole and Propranolol and to do neck ultrasound as outpatient and follow-up TSI and TRab results and repeat free T4 and T3 in 1 week. Her neck ultrasound revealed mild hypervascularity but no Graves’ features. Her TSI and TRab were negative and free T4 level had no improvement even on significant dose of Methimazole. All the findings argue against Graves’ disease, but support subacute thyroiditis. Then Methimazole was discontinued and Prednisone was started at 20 mg daily and quickly taper to 5 mg daily in 2 weeks then stopped. After on Prednisone for 3 weeks, her free T4 was close to normal at 2. 0 ng/dl, T3 normal at 120 ng/dl, although TSH is suppressed. After stopped Prednisone for 2 weeks, her free T4, T3 and TSH were all back to normal. She is currently euthyroid without any medication at 5 months after her initial presentation. Conclusion Treatment of patients with subacute thyroiditis is pain relief with NSAID or Prednisone when NSAID is not effective. Anti-thyroid medications are rarely effective even in subacute thyroiditis patient with thyroid storm. Our case illustrated the role of corticosteroids in the treatment of subacute thyroiditis patient with severe thyrotoxicosis. Neck ultrasound and thyroid antibodies including TSI and TRab are critical to make a correct diagnosis in subacute thyroiditis patient with severe thyrotoxicosis. Presentation: No date and time listed

Subacute thyroiditis

Subacute thyroiditis (de Kerven's thyroiditis, giant cell thyroiditis, granulomatous thyroiditis) - a self-limiting inflammatory disease of the thyroid gland (thyroid gland), presumably of viral etiology, is the most common cause of pain in the thyroid gland. The disease (probably without an autoimmune component) is characterized by a 4-phase course (thyrotoxicosis, euthyroidism, hypothyroidism and restoration of normal functioning of the thyroid gland), its duration is from several weeks to several months. The subacute thyroiditis was first described by de Kerven in 1904. In most cases, if the disease has a characteristic clinical picture, the diagnosis of subacute thyroiditis is not difficult and, with adequate treatment, the patient will recover completely.

Thyroïdite non douloureuse à cellules géantes. À propos d'un cas

We report a case of painless giant cell thyroiditis with inflammatory syndrome, hypothyroidism, and multinodular goiter regressive after steroid treatment. The association with headache rises the question of its relation with giant cell arteritis.

Painless giant cell thyroiditis diagnosed by fine needle aspiration and associated with intense thyroidal uptake of gallium

A 52-year-old woman presented with fever, goiter, and no evidence of pain or tenderness in the thyroid. A diagnosis of silent thyroiditis was made after obtaining evidence of biochemical thyrotoxicosis, intense gallium-67 citrate thyroidal localization, and cytologic thyroiditis. Fine needle aspiration biopsy of the thyroid revealed numerous giant cells in all areas of the thyroid, typical of subacute thyroiditis. This is believed to be the first time painless thyroiditis is reported with the classic cytologic feature of painful subacute thyroiditis.

SUBACUTE GRANULOMATOUS THYROIDITIS: A REVIEW

Excerpt Subacute granulomatous thyroiditis has been described by many names. Commonly used synonyms are: giant cell thyroiditis, pseudotuberculous thyroiditis, acute simple thyroiditis, acute nonsu...

Granulomatous thyroiditis (De Quervain's thyroiditis).

GRANULOMATOUS thyroiditis is a distinct clinicopathologic entity, apparently a true nonsuppurative inflammation of the thyroid gland, that can be distinguished from the rare invasive fibrous thyroiditis (Riedel's struma) or the more common struma lymphomatosa. Since its first description by de Quervain in 1904 (1), the disease has been reported under many synonyms. Terms that call attention to the histologic features of the lesion include “pseudotuberculous thyroiditis,” “granulomatous thyroiditis,” “giant-cell thyroiditis” or “struma fibrosa, giant-cell variant.” The clinical findings have given origin to such names as “acute and subacute nonsuppurative thyroiditis,” “acute noninfectious thyroiditis,” “acute diffuse thyroiditis” and “subacute thyroiditis.” The latter term is commonly used. However, since there appears to be one basic pathologic process with extreme variation in severity of symptoms, and since many cases undoubtedly occur in which subjective symptoms are absent, it was thought best to use...

Diagnosis and management of thyroiditis.

• In 1,309 operations on the thyroid gland, various forms of thyroiditis were encountered in 117 patients, excluding 83 other patients in whom a focal thyroiditis was associated with diffuse toxic and adenomatous goiter and carcinoma. Among the 117 patients there were 28 with acute and 89 with chronic thyroiditis. The acute thyroiditis led to suppuration in 6 patients; they required surgical incision and drainage, and all recovered with the aid of antibiotics, chemotherapy, and supportive measures. There were 22 patients in whom the acute thyroiditis did not go on to suppuration; antibiotic and x-ray therapy sufficed in 8 of these, but surgery was necessary in 14. The 89 patients with chronic thyroiditis were classified, upon examination of tissues removed at operation, as having Hashimoto's disease in 67, giant cell thyroiditis (granulomatous thyroiditis) in 16, and Riedel's struma in 6 cases. Surgical treatment of these forms of chronic thyroiditis is necessary in order to restore a normal appearance to the neck, to relieve pressure especially on the trachea, and to obtain adequate tissue specimens for diagnosis. Aspiration biopsies have not always yielded adequate specimens, and radiation therapy given in quantities sufficient to reduce the size of the thyroid also reduces its function. In this series of cases there were neither operative deaths nor serious postoperative complications.

Subacute thyroiditis; report of three cases treated with cortisone.

Although first described as a clinical entity in 1904,¹subacute thyroiditis has remained virtually unknown to most physicians. Only recently has there been an upsurge of interest in the inflammatory conditions of the thyroid gland. Whereas Cecil's "Textbook of Medicine," seventh edition (1947),²barely mentions it among acute thyroid conditions, the ninth edition (1955) devotes an entire column to it. The clinical and histological picture was clearly described in 1904 by de Quervain, who collected cases from the literature going back almost 100 years. He distinguished primary nonsuppurative thyroiditis from secondary thyroiditis occurring in a variety of infectious diseases, such as typhoid and malaria. In 1936 he added 8 cases and collected 62 more from the literature.³ There are several names for this disease, such as, de Quervain's thyroiditis, acute recurrent, pseudotuberculous, and giant-cell thyroiditis. It is nowadays usually designated as subacute thyroiditis.⁴This term distinguishes

Cortisone versus x-ray in the treatment of subacute thyroiditis: a report of four cases.

Article1 June 1956CORTISONE VERSUS X-RAY IN THE TREATMENT OF SUBACUTE THYROIDITIS: A REPORT OF FOUR CASESLAWRENCE TAYLOR, M.D.LAWRENCE TAYLOR, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-44-6-1082 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptReports of successful treatment of subacute thyroiditis (DeQuervain's, pseudotuberculous, giant cell thyroiditis) have included the use of x-ray, thiouracil, ACTH, cortisone and thyroid-stimulating hormone. The average duration of subacute thyroiditis following x-ray therapy was 19 days in Crile's series,1although two cases received two or more courses over a period of three months. Portmann,2however, reported 46 of 47 patients apparently cured with one or two courses of x-ray therapy, the patient not cured having received only one course. Robbins3reported five of six patients improved within two days following thyroid-stimulating hormone, 20 to 30 mg. intramuscularly daily for from...Bibliography1. Crile G: Thyroiditis, Ann. Surg. 127: 640-654, 1948. CrossrefGoogle Scholar2. Portmann UV: Clinical therapeutic radiology, 1950, Thomas Nelson and Sons, New York, p. 177. Google Scholar3. RobbinsRallTrunnellRawson JJEJBRW: The effect of thyroid stimulating hormone in acute thyroiditis, J. Clin. Endocrinol. 11: 1106-1115, 1951. CrossrefGoogle Scholar4. KingRossellini BTH: Treatment of acute thyroiditis with thiouracil, preliminary report, J. A. M. A. 129: 267-268, 1945. CrossrefGoogle Scholar5. Crile G: Thyroiditis, Ann. Int. Med. 37: 519, 1952. LinkGoogle Scholar6. Lasser RP: Subacute thyroiditis treated with cortisone, J. A. M. A. 152: 1133-1134, 1953. CrossrefMedlineGoogle Scholar7. KahnSpritzlerShector JRJWE: Cortisone treatment of subacute non-suppurative thyroiditis: report of 2 cases, Ann. Int. Med. 39: 1129-1133, 1953. LinkGoogle Scholar8. Landman HR: Acute thyroiditis treated with cortisone, Am. Pract. 5: 130-131, 1954. Google Scholar9. GelfandLittleHoffman MLASKF: The treatment of subacute non-suppurative thyroiditis with cortisone, Am. J. M. Sc. 229: 69-73, 1955. CrossrefMedlineGoogle Scholar10. HunterSheehan RCDJ: Treatment of subacute thyroiditis with cortisone, New England J. Med. 251: 174-176, 1954. CrossrefMedlineGoogle Scholar11. Kinsell LW: The clinical application of pituitary adrenocorticotropic and adrenal steroid hormones, Ann. Int. Med. 35: 615-651, 1951. LinkGoogle Scholar12. RoweLambTaylorKinsell AGRFBLW: Experience with cortisone and ACTH in private practice, California Med. 75: 11, 1951. MedlineGoogle Scholar13. Duncan GG: Diseases of metabolism, 3d Ed., 1952, W. B. Saunders Co., Philadelphia, p. 980. Google Scholar14. HardyRiegelErisman JDCEP: Experience with protein bound iodine: the effect of ACTH and cortisone on thyroid function, Am. J. M. Sc. 220: 290-292, 1950. CrossrefMedlineGoogle Scholar15. Perry WF: The action of cortisone and ACTH on thyroid function, Endocrinology 49: 284-288, 1951. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Bryn Mawr, Pennsylvania*Received for publication January 17, 1956.From the Department of Medicine, Bryn Mawr Hospital, Bryn Mawr, Pennsylvania. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited bySubacute thyroiditisDie Strahlentherapie gutartiger Erkrankungen innersekretorischer DrüsenDie Strahlentherapie gutartiger Erkrankungen innersekretorischer DrüsenPrednisone for Treatment of Subacute ThyroiditisSubacute Thyroiditis Treated with Salicylate 1 June 1956Volume 44, Issue 6Page: 1082-1087KeywordsAdrenocorticotropic hormoneEdemaGiant cellsHospital medicineProteinsThyroidThyroid-stimulating hormone ePublished: 1 December 2008 Issue Published: 1 June 1956 PDF downloadLoading ...

Treatment of subacute thyroiditis with corticotropin.

Three distinct entities comprise most cases of subacute or chronic nonsuppurative thyroiditis: subacute nonsuppurative giant cell thyroiditis, struma lymphomatosa (Hashimoto's disease), and Riedel's struma (woody or ligneous thyroiditis). In the past it was believed that these represented stages in the progression of the same disease, but recent clinical and pathological studies have shown them to be separate diseases. Subacute nonsuppurative thyroiditis has also been called pseudotuberculous or giant cell thyroiditis because of the formation of tiny miliary pseudotubercles by polymorphonuclear infiltration of colloid follicles. The cause is unknown. Clinically, the disease is characterized by a painful, tender, firm, usually diffuse enlargement of the thyroid gland, with fever, pain on swallowing, hyperthyroidism at least in the beginning of the disease, elevated sedimentation rate, and polymorphonuclear leukocytosis. The disease is usually self-limited; it runs a variable course for weeks or months and eventually subsides without any permanent impairment of thyroid function, although

Chronic thyroiditis: a clinical and pathologic study of 354 patients.

CHRONIC thyroiditis, as evidenced by lymphoid infiltration, fibrosis and epithelial alteration of the thyroid gland, is a poorly defined thyroid disorder. Since the classic descriptions of Riedel (1, 2, 3) and Hashimoto (4), numerous controversial reports on chronic thyroiditis have appeared in the literature (5–24). These have not shown uniform opinions on the etiology, pathogenesis, classification and terminology or treatment of this group of thyroid diseases. The present report is concerned primarily with a pathologic appraisal of 195 thyroid glands which displayed three types of diffuse thyroiditis, 1) lymphadenoid goiter (“Hashimoto” thyroiditis, struma lymphomatosa), 2) granulomatous or giant-cell thyroiditis, and 3) “Riedel” thyroiditis (Table 1). Included in this study were an additional 159 glands in which the chronic thyroiditis of the “Hashimoto” type was either focal or was associated with other diseases of the thyroid gland (Table 2). The purposes of this paper are 1) to describe and illustra...

TREATMENT OF THYROIDITIS

THE THREE main and distinct clinical types of thyroiditis are (1) the subacute (pseudotuberculous or giant cell) variety, (2) struma lymphomatosa (Hashimoto's thyroiditis) and (3) Riedel's struma. 1 Subacute thyroiditis resolves promptly and completely in response to roentgen therapy; some, and possibly most, cases of struma lymphomatosa respond favorably to roentgen rays, but Riedel's struma is unaffected by irradiation. SUBACUTE THYROIDITIS Subacute thyroiditis is a self-limited disease of unknown causation. It has a variable course of weeks or months and eventually subsides without treatment and without significant interference with the function of the thyroid. This type of thyroiditis has been variously named tuberculous, pseudotuberculous or giant cell thyroiditis because of the histologic appearance of pseudotubercles with giant cells. Tubercle bacilli cannot be demonstrated in the lesions, and the cause of the disease is unknown. Bacteria have not been demonstrated in the thyroid. The possibility that it represents a virus infection