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🎙️ Deep Dive: Subacute (De Quervain’s) Thyroiditis – Viral Inflammation, Phases & Prognosis 🔥🦋🩺


In this episode, we’re unpacking Subacute Thyroiditis (De Quervain’s) — a self-limiting but high-yield endocrine condition for the MSRA. 💡 Whether you're revising thyroid pathology or trying to distinguish it from Graves’, Hashimoto’s or silent thyroiditis — this one’s essential!


🔍 In this podcast, you’ll learn:


✅ Definition
→ Inflammatory, painful thyroid condition post-viral illness 🌡️
→ Self-limiting and typically resolves on its own 💪


✅ The 4 Clinical Phases

1.

Hyperthyroid phase (weeks) – neck pain, high T4, low TSH

2.

Euthyroid phase – transient "normal" labs

3.

Hypothyroid phase – low T4, high TSH

4.

Recovery – normal thyroid function 🎯


✅ Cause & Pathophysiology
→ Likely post-viral (e.g., coxsackievirus, mumps) 🦠
→ Autoimmune inflammation damages thyroid follicles → release of preformed T4 → followed by transient hormone depletion 🧬


✅ Symptoms
→ Severe anterior neck pain, tender goitre, fever, malaise
→ Initial hyperthyroid symptoms (palpitations, tremor, weight loss)
→ Later hypothyroid phase, often mild or asymptomatic


✅ Differentials
→ Distinguish from:

•

Graves’ (high iodine uptake, eye signs 👁️)

•

Hashimoto’s (painless chronic hypo 🧊)

•

Silent thyroiditis (similar pattern, but painless)

•

Thyroid abscess or bacterial thyroiditis


✅ Diagnosis
→ TFT pattern: high T4, low TSH → then flips
→ 🔥 High ESR/CRP
→ 🧪 Radioiodine uptake: LOW in hyperthyroid phase — key diagnostic clue!


✅ Management
→ 🎯 NSAIDs first-line for pain
→ 💊 Prednisolone if pain severe or NSAIDs fail
→ 🧘‍♀️ Beta-blockers (e.g., propranolol) for thyrotoxic symptoms
→ 💊 Levothyroxine only in significant/symptomatic hypothyroidism
→ 💬 Reassurance and monitoring — most recover without long-term meds!


✅ Prognosis
→ Excellent! ✅
→ 90% recover fully within months
→ Rare persistent thyroid dysfunction or recurrence


📚 MSRA Revision Resources for Subacute Thyroiditis:


📄 Revision Notes:
https://www.passthemsra.com/topic/subacute...


🃏 Flashcards:
https://www.passthemsra.com/topic/subacute...


📖 Accordion Q&A Notes:
https://www.passthemsra.com/topic/subacute...


🧪 Rapid Quiz:
https://www.passthemsra.com/topic/subacute...


📝 Quiz Page:
https://www.passthemsra.com/quizzes/subacu...


📌 Takeaway Tip:
If it’s painful + post-viral + low radioiodine uptake, think De Quervain’s!
💥 Don't confuse it with painless thyroiditis or Graves’ — this one hurts!


🎯 Lock this in for the MSRA and ace your endocrine questions!


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