Subacute Thyroiditis and Painless Thyroiditis: Clinical Characteristics of 221 Patients Diagnosed between 2009 and 2015

Jung Ah Choi; Yong Hyun Kim; Dong Hyun Shin; Jae Min Lee; Jin Young Heo; Hyun Mi Kim; Won Il Park; Chul Young Kim; In Hye Lee; Ji Su Kim; Go Eul Kim

doi:10.11106/ijt.2016.9.2.145

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Choi, Kim, Shin, Lee, Heo, Kim, Park, Kim, Lee, Kim, and Kim: Subacute Thyroiditis and Painless Thyroiditis: Clinical Characteristics of 221 Patients Diagnosed between 2009 and 2015

Original Article

Int J Thyroidol 2016;9(2):145-151.

Published online: 20 November 2016

DOI: https://doi.org/10.11106/ijt.2016.9.2.145

Subacute Thyroiditis and Painless Thyroiditis: Clinical Characteristics of 221 Patients Diagnosed between 2009 and 2015

Jung Ah Choi, Yong Hyun Kim, Dong Hyun Shin, Jae Min Lee, Jin Young Heo, Hyun Mi Kim, Won Il Park, Chul Young Kim, In Hye Lee, Ji Su Kim, Go Eul Kim

Department of Internal Medicine, Bundang Jesaeng Hospital, Seongnam, Korea

Correspondence: Yong Hyun Kim, MD, PhD, Department of Internal Medicine, Bundang Jesaeng Hospital, 20 Seohyeon-ro 180beon-gil, Bundang-gu, Seongnam 13590, Korea Tel: 82-31-779-0696, Fax: 82-31-779-0897, E-mail: yhk@dmc.or.kr

Received 7 March 2016 Revised 9 June 2016 Accepted 8 July 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background and Objectives

In the past, subacute thyroiditis causing thyrotoxicosis included both painful and painless subgroup, but it is representative for the painful subacute thyroiditis these days. So we evaluated the clinical and laboratory characteristics of subacute thyroiditis and compared with the painless (silent) thyroiditis, and identified predictive factors of permanent hypothyroidism and recurrence.

Materials and Methods

This was a retrospective case series study analyzing clinical data of 221 consecutive patients diagnosed between 2009 and 2015. Medical records were reviewed for diagnostic route, age distribution, laboratory data, clinical course and long-term follow up outcome.

Results

The mean age was 48 years; female v/s male ratio 3.4:1. Median disease duration was 110 days; mean peak free T4 level was 2.9 ng/dL. 56.7% of painless thyroiditis patients were diagnosed on health checkup or routine thyroid function test with symptoms not typically associated with thyrotoxicosis. Permanent hypothyroidism was not uncommon (11/221; 5.0%). Higher peak thyroid-stimulating hormone (TSH) was associated with permanent hypothyroidism in painless thyroiditis. Lower peak TSH was associated with recurrence rate in both subacute and painless thyroiditis. In painless thyroiditis, short duration of thyrotoxicosis phase was also associated with recurrence rate.

Conclusion

Considerable numbers of painless thyroiditis without symptoms were diagnosed on health checkup. Higher peak TSH was associated with permanent hypothyroidism in painless thyroiditis. Recurrence rate was related with lower peak TSH in both groups.

Keywords: Subacute thyroiditis, Painless thyroiditis, Postpartum thyroiditis, Permanent hypothyroidism, Recurrence

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Fig. 1.

Age distribution of subacute and painless thyroiditis, including postpartum painless thyroiditis patients (postpartum thyroiditis is not included in painless thyroiditis in this figure).

Table 1.

Laboratory findings of subacute thyroiditis and painless thyroiditis

	All patients (n=221)	Subacute thyroiditis (n=64)	Painless thyroiditis (n=157)	p value
Age (years) (median, range)	48 (23–88)	50.5 (26–76)	47.0 (23–88)	0.078^§
Female gender (%)	77 (171/221)	88 (56/64)	73 (115/157)	0.032^†
ESR (mm/h) (mean±SD)	36.5±33.2	59.2±37.0	27.0±26.7	＜0.001^§
Anti-TPO antibody (%)	21 (9/43)	14 (2/14)	24 (7/29)	0.693^‡
Anti-TSH receptor antibody (%)	6 (8/133)	3 (1/27)	6 (7/106)	＞0.999^‡
Peak FT4 (ng/dL) (mean±SD)	2.93±3.3	4.0±5.8	2.5±1.3	0.738^§
Duration of thyrotoxicosis (days)	52.9	39.5	59.1	0.038^§
Peak TSH (mU/L) (median)	22	21	22	0.057^§
Overall duration (days) (median)	110	120	106	0.800^§
Permanent hypothyroid (%)	5 (11/221)	8 (5/64)	4 (6/157)	0.304^‡
Recurrence (%)	12 (28/221)	9 (6/64)	14 (22/157)	0.994^‡

^§ Mann-Whitney U-test

^† Chi-squared test by two-sided Pearson' s exact test

^‡ Chi-squared test by two-sided Fisher' s exact test

FT4: free thyroxine, TPO: thyroid peroxidase, TSH: thyroid stimulating hormone

Table 2.

Laboratory findings of subacute and painless thyroiditis according to permanent hypothyroidism

	Subacute patients (n=64)	Permanent hypothyroidism in subacute thyroiditis (n=5)	p value	Painless thyroiditis (n=157)	Permanent hypothyroidism in painless thyroiditis (n=6)	p value
Anti-TPO antibody (%)	14 (2/14)	0 (0/2)	＞0.999^†	24 (7/29)	66 (2/3)	0.136^†
Anti-TSH receptor antibody (%)	3 (1/27)	0 (0/1)	＞0.999^†	6 (7/106)	33 (1/3)	0.178^†
Peak TSH (mU/L) (median)	21	35	0.127^∗	22	53	＜0.001^∗
Overall duration (days) (median)	120	430	＜0.001^∗	106	868	＜0.001^∗

^∗ Mann-Whitney U-test

^† Chi-squared test by two-sided Pearson' s exact test

TPO: thyroid peroxidase, TSH: thyroid stimulating hormone

Table 3.

Laboratory findings of subacute and painless thyroiditis according to recurrence

	Subacute thyroiditis patients (n=64)	Recurrence in subacute thyroiditis (n=6) (9%)	p value	Painless thyroiditis (n=157)	Recurrence in painless thyroiditis (n=22) (14%)	p value
Peak TSH (mU/L)	21	12.72	0.007^∗	22	6.38	0.018^∗
Peak FT4 (ng/dL) (mean±SD)	4.0±5.8	2.5±1.3	0.991^∗	2.5±1.3	2.9±1.3	0.086^∗
Duration of thyrotoxicosis (days) (mean)	39.5	56.3	0.325^∗	59.1	48.6	0.001^∗
Overall duration (days) (median)	120	100	0.566^∗	106	112	＜0.001^∗

^∗ Mann-Whitney U-test

FT4: free thyroxine, SD: standard deviation, TSH: thyroid stimulating hormone

Table 4.

Clinical characteristics of painless thyroiditis patients according to postpartum history

	Postpartum thyroiditis (n=15)	Non-postpartum painless thyroiditis (n=142)	p value
Age (years) (median, range)	35 (32–41)	49.5 (23–88)	＜0.001^§
Female gender (%)	100 (15/15)	70 (100/142)	0.012^†
Anti-TPO antibody＞60 (%)	60 (3/5)	17 (4/24)	0.075^†
Anti-TSH receptor antibody＞10 (%)	15 (2/13)	5 (5/93)	0.187^†
Peak FT4 (ng/dL) (mean±SD)	2.2±1.2	2.7±1.6	0.135^§
Peak TSH (mU/L)	36.87	19.93	0.071^§
Liver function test abnormality (%)	30 (3/10)	17 (21/124)	0.384^†
Hypothyroid phase (%)	53 (8/15)	31 (44/142)	0.091^†
Permanent hypothyroid (%)	20 (3/15)	2 (3/142)	0.012^†
Recurrent disease (%)	13 (2/15)	14 (20/142)	＞0.999^†

^§ Mann-Whitney U-test

^† Chi-squared test by two-sided Pearson' s exact test

^‡ Chi-squared test by two-sided Fisher' s exact test

FT4: free thyroxine, SD: standard deviation, TPO: thyroid peroxidase, TSH: thyroid stimulating hormone

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