What causes subacute granulomatous thyroiditis?

Updated: Mar 23, 2021
  • Author: Stephanie L Lee, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

The most accepted etiology for this condition is a viral illness. [6] Viral particles have never been identified within the thyroid, but episodes often follow upper respiratory infections and are associated with falling postconvalescent viral titers of various viruses, including influenza, adenovirus, mumps, and coxsackievirus. The occurrence of subacute granulomatous thyroiditis in the course of novel H1N1 influenza infection has been reported from Greece. [7]

De Quervain thyroiditis is not associated with autoimmune thyroiditis. The transient presence of autoantibodies (eg, inhibitory immunoglobulins that bind to TSH, antibodies that block thyroid stimulation, thyroid antimicrosomal antibodies, thyroglobulin [TG] antibodies) has been noted in the acute phase of the disease, but this has been attributed to a virally induced autoimmune response and has not been implicated in the pathologic process. (Viral inclusion bodies are not observed in thyroid tissue in subacute granulomatous thyroiditis.)

It is unclear, however, whether the destructive thyroiditis in De Quervain patients is caused by direct viral infection of the gland or by the host's response to the viral infection.

In contrast to autoimmune thyroid disease, the immune response in subacute granulomatous thyroiditis is not self-perpetuating; therefore, the process is limited.


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