Other thyroiditis: de Quervain, painless, Riedel
- Lesion
Besides Hashimoto, the thyroid can be inflamed after a virus, after childbirth or by scarring. Some types hurt; most get better.
What it is
Thyroiditis means inflammation of the thyroid, and each type has its own trigger, histology and course. Subacute granulomatous thyroiditis follows a viral infection and is painful; painless and postpartum thyroiditis are autoimmune and silent; Riedel thyroiditis is a rare fibrosing disease in the IgG4 family; acute infectious thyroiditis is a bacterial abscess. The destructive types often show a three-phase course of thyrotoxicosis, hypothyroidism and recovery.
Thyroiditis types side by side
| Type | Trigger | Pain | Histology | Course |
|---|---|---|---|---|
| Hashimoto | Autoimmune | No | Germinal centres, Hürthle cells, fibrosis | Permanent hypothyroidism |
| Subacute granulomatous | Viral infection | Yes, tender | Granulomas with multinucleated giant cells around colloid | Thyrotoxic, hypothyroid, recovers |
| Painless (lymphocytic) | Autoimmune | No | Lymphocytes, no germinal centres or Hürthle cells | Same three phases; may recur |
| Postpartum | Autoimmune, within a year of delivery | No | As painless thyroiditis | Often recurs; later hypothyroidism risk |
| Riedel | Fibroinflammatory, often IgG4 | No | Dense fibrosis crossing the capsule | Compression of trachea, nerves |
| Acute infectious | Bacteria | Yes, with fever | Abscess, neutrophils | Resolves with drainage and antibiotics |
Clinical notes
- Neck pain radiating to the jaw or ear with a tender gland is subacute thyroiditis until proven otherwise.
- Riedel can cause stridor, dysphagia and hoarseness, and can coexist with retroperitoneal fibrosis.
- Thyrotoxicosis from leakage is treated with beta-blockers, not antithyroid drugs.
Test yourself
Think of the answer, then tap the question to see it.
What does subacute granulomatous thyroiditis look like under the microscope?
Disrupted follicles with granulomatous inflammation and multinucleated giant cells engulfing colloid, plus mixed inflammation.
Why is iodine uptake low in the thyrotoxic phase of painless thyroiditis?
The hormone is leaking from damaged follicles, not being newly made, and TSH is suppressed.
Which disease family does Riedel thyroiditis often belong to?
IgG4-related disease.
Elsewhere in DurgiPedia
- Granulomatous inflammation: caseating vs non-caseating, the causes to know
- Fibrosis in organs: TGF-β and the myofibroblast
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Thyroid Diseases (MedlinePlus, US National Library of Medicine, 2025).
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Representative model, for educational purposes only.