De Quervain Thyroiditis (SAT: Subacute Thyroiditis)

De Quervain thyroiditis  Subacute thyroiditis (SAT) was first described by de Quervain in 1905 (Fritz de Quervain (18681940), a Swiss surgeon).  usually occurs following an upper respiratory tract viral infection.  selflimiting inflammatory condition.  20–50 years, ratio femalemale: 5:1. Vladimir P. Kharchenko, Ultrasound Diagnostics of Thyroid Diseases Robert A. Sofferman, Ultrasound of the Thyroid and Parathyroid Glands

De Quervain Thyroiditis (SAT: Subacute Thyroiditis) BS Nguyễn Tuấn Cường Medic Sudden neck pain Enlarged thyroid Vs  , TSH ↓ Hypoechoic areas Diagnosis? De Quervain thyroiditis  Subacute thyroiditis (SAT) was first described by de Quervain in 1905 (Fritz de Quervain (1868-1940), a Swiss surgeon)  usually occurs following an upper respiratory tract viral infection  self-limiting inflammatory condition  20–50 years, ratio female/male: 5:1 Vladimir P Kharchenko, Ultrasound Diagnostics of Thyroid Diseases Robert A Sofferman, Ultrasound of the Thyroid and Parathyroid Glands The clinical classification of SAT is as follows (Balabolkin 1994): SAT with an expressed inflammatory reaction (54.8%) Slowly progressing SAT (28.2%) SAT with clinical hyperthyroidism (14.6%) Pseudoneoplastic SAT (2.4%) Vladimir P Kharchenko, Ultrasound Diagnostics of Thyroid Diseases Robert A Sofferman, Ultrasound of the Thyroid and Parathyroid Glands Basic US features:  Thyroid enlargement  Local or diffuse decrease in echodensity (Hypoechoic areas of various sizes and shapes with indistinct margins)  Pain upon the compression of the thyroid by the US probe, especially at sites where the echodensity decreases  Significant decrease in vascularity in hypoechoic areas  Cervical lymphadenitis can be detected in the acute period Vladimir P Kharchenko, Ultrasound Diagnostics of Thyroid Diseases Hypoechoic lesion in one lobe Not well-marginated Decreased vascularity PROGRESSION  Thyroid structure becomes normal again in about 75% of patients: may take from two months up to 1.5 years  Residual changes can be observed in 25% of the patients  SAT recurrence arises in 30–35% of patients Vladimir P Kharchenko, Ultrasound Diagnostics of Thyroid Diseases Present abnormal trends: The clinical characteristics of subacute thyroiditis (SAT) has been changing in recent years  More patients with painless SAT, and with elevated levels of anti-thyroid antibodies  The Anti-TPO and Anti-Tg levels were increased in 15.5% and 33.3% of patients, respectively TRAb level was increased in 6% of patients Stasiak M1, Clinical characteristics of subacute thyroiditis is different than it used to be - current state based on 15 years own material, Neuro Endocrinol Lett 2019 Feb;39(7):489-495 Prensent abnormal trends(cont):  The frequency of recurrence of subacute thyroiditis (SAT) is 30-35% The reason for SAT relapse is still unknown  The recurrence rate was significantly increased in patients with HLA-B*18:01 plus HLA-B*35  There is a considerable overlap between the sonographic features of atypical subacute thyroiditis and thyroid malignancy (mostly in patients with the presence of only HLA-B*18:01) Stasiak M1, The Risk of Recurrence of Subacute Thyroiditis Is HLA-Dependent, Int J Mol Sci 2019 Mar 3;20(5) Cytology  FNA is not frequently needed  Acute stage: unclear result: atypical follicular lesion (Bethesda III and even IV) -> wrong management  Later stage: classic changes of granulomatous thyroiditis Especially, an experienced cytopathologist  Robert A Sofferman, Ultrasound of the Thyroid and Parathyroid Glands Treatment  Pain and thyroid dysfunction  NSAIDs Prednisone 15-20mg/day initially, if pain does not response within days, the diagnosis should be reconsidered    Thyrotoxicosis: beta-blockants Hypothyroidism: temporary After one month After two months After three months Quick improvement after one month Conclusion  Common signs of de Quervain Thyroidits: sudden neck pain, tender thyroid and  Vs  Ultrasound is very good at diagnosing and following the process  Classic characteristics have been changing: more painless, atypical ultrasound, presence of anti-thyroid antibody, high recurrence  FNAC, if needed, read by an experienced cytopathologist Conclusion(cont)  Residual changes can be observed in 25% of the patients  Skillfull combination use of clinical and ultrasound findings can reduce unnecessary operative intervention  ...Sudden neck pain Enlarged thyroid Vs  , TSH ↓ Hypoechoic areas Diagnosis? De Quervain thyroiditis  Subacute thyroiditis (SAT) was first described by de Quervain in 1905 (Fritz de Quervain. .. HLA-B*18:01) Stasiak M1, The Risk of Recurrence of Subacute Thyroiditis Is HLA-Dependent, Int J Mol Sci 2019 Mar 3;20(5) Cytology  FNA is not frequently needed  Acute stage: unclear result: atypical... probe, especially at sites where the echodensity decreases  Significant decrease in vascularity in hypoechoic areas  Cervical lymphadenitis can be detected in the acute period Vladimir P Kharchenko,