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# 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.

Updated Nov 12, 2026

## Key points

- Subacute granulomatous (de Quervain): after a viral URI, painful tender gland, fever, high ESR, granulomas with giant cells around colloid.
- Painless and postpartum thyroiditis: autoimmune lymphocytic infiltrate without germinal centres or Hürthle cells, often anti-TPO positive.
- Destructive pattern: hormone leaks (thyrotoxic, low iodine uptake), then hypothyroid, then usually euthyroid.
- Riedel thyroiditis: stony-hard gland, fibrosis extending into neck structures, mimics carcinoma; IgG4-related in many cases.
- Acute infectious thyroiditis: bacteria, often via a pyriform sinus fistula in children.

## 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](https://durgical.com/en/conditions/hypothyroidism/) | Autoimmune | No | Germinal centres, Hürthle cells, fibrosis | Permanent hypothyroidism |
| [Subacute granulomatous](https://durgical.com/en/conditions/thyroiditis/) | Viral infection | Yes, tender | Granulomas with multinucleated giant cells around colloid | Thyrotoxic, hypothyroid, recovers |
| [Painless (lymphocytic)](https://durgical.com/en/conditions/thyroiditis/) | Autoimmune | No | Lymphocytes, no germinal centres or Hürthle cells | Same three phases; may recur |
| [Postpartum](https://durgical.com/en/conditions/thyroiditis/) | Autoimmune, within a year of delivery | No | As painless thyroiditis | Often recurs; later hypothyroidism risk |
| [Riedel](https://durgical.com/en/conditions/igg4-related-disease/) | 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.

## Memory aid

De Quervain hurts and makes giant cells eat colloid; the silent and postpartum types sneak in without pain; Riedel turns the gland to wood.

## 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.

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## Elsewhere in DurgiPedia

- [Granulomatous inflammation: caseating vs non-caseating, the causes to know](https://durgical.com/en/general-pathology/granulomatous-inflammation-caseating-vs-non-caseating-the-causes-to-know/)
- [Fibrosis in organs: TGF-β and the myofibroblast](https://durgical.com/en/general-pathology/fibrosis-in-organs-tgf-and-the-myofibroblast/)

## Connections

## Related 4

- [Hashimoto thyroiditis](https://durgical.com/en/general-pathology/hashimoto-thyroiditis/)
- [Thyrotoxicosis: causes](https://durgical.com/en/general-pathology/thyrotoxicosis-causes/)
- [Autoimmune pancreatitis: type 1 (IgG4-related) vs type 2](https://durgical.com/en/general-pathology/autoimmune-pancreatitis-type-1-vs-type-2/)
- [Granulomatous inflammation: caseating vs non-caseating, the causes to know](https://durgical.com/en/general-pathology/granulomatous-inflammation-caseating-vs-non-caseating-the-causes-to-know/)

## Related conditions 4

- [Thyroiditis (subacute, painless and postpartum)](https://durgical.com/en/conditions/thyroiditis/)
- [IgG4-related disease](https://durgical.com/en/conditions/igg4-related-disease/)
- [Graves disease (hyperthyroidism)](https://durgical.com/en/conditions/graves-disease/)
- [Hypothyroidism](https://durgical.com/en/conditions/hypothyroidism/)

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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](https://medlineplus.gov/thyroiddiseases.html) (MedlinePlus, US National Library of Medicine, 2025).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/other-thyroiditis-de-quervain-painless-riedel/