De Quervain's thyroiditis

Vignette says a 12 year old female presents the to endocrinology clinic with complaints of painful anterior neck swelling for 15 days; She also reports of palpitations, sweating and difficulty sleeping; She recently had upper respiratory infection (URI) prior to the appearance of neck pain; Vital signs show blood pressure of 110/80 mm of Hg, pulse rate of 102 bpm, respiratory rate of 18 breaths/min, oxygen saturation of 92% in RA and temperature of 99.9 F; Local examination shows diffusely enlarged, tender thyroid glands on palpation; TFT shows low TSH and high T3, & T4 levels; Radioactive iodine uptake (RAIU) is decreased; Diagnosis? 

Diagnosis is De Quervain's thyroiditis (subacute granulomatous thyroiditis). 

De Quervain's thyroiditis is a self-limiting inflammatory condition of the thyroid gland which is commonly triggered by viral infection and is usually associated with HLA-B35.

Clinical features include a history of flu-like illness, i.e. fever and URI (e.g. viral infection), preceded by painful thyroid swelling and neck pain. It presents with the triad of fever, painful thyroid swelling and neck pain.
It leads to transient hyperthyroidism (due to rupture of thyroid follicular cells), followed by an euthyroid state and then hypothyroidism. Patients may be euthyroid, hyperthyroid, or hypothyroid, or may evolve from one to another over time.

Diagnosis:- 
1. TFT usually shows hyperthyroid state as patients present in acute phase, i.e. low TSH and high T3, & T4 levels. 
2. ESR is elevated. 
3. Radioactive iodine uptake (RAIU) is decreased. 
4. Biopsy shows granulomatous inflammation (consisting of giant cells clustered with foci of degenerating thyroid follicles).

Treatment:- Most patients return to normal state within 12-18 months (It is a self-limiting disease). 
1. Analgesics:- Aspirin, NSAIDs are given for mild symptoms, whereas steroids are given for severe symptoms. 
2. Hyperthyroid state is managed with propranolol, whereas hypothyroid state is managed with levothyroxine along with TFT monitoring.