Subacute thyroiditis (or de Quervain's disease) is a relatively uncommon form of thyroiditis characterized pathologically by the presence of extensive follicular cell destruction, extravasation of colloid and aggregation of histiocytes around colloid, coalescing into giant cells. There is strong but indirect evidence that this pathology may result as a reaction to a preceding viral infection, but immune mechanisms may also play a role. Patients often present with cervical pain, tenderness of the thyroid (at times exquisite), symptoms of thyrotoxicosis and in some cases, systemic symptoms of an inflammatory illness. Thyrotoxicosis results from an unregulated release of preformed thyroid hormone from an inflamed gland. As the thyroid gland is depleted of preformed hormone and the thyroiditis subsides, the serum T4 and T3 concentrations fall to normal and in some cases to subnormal levels, before recovery of the gland with normalization of function. The entire course of the illness may last as long as 6-9 months, at times longer.
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