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Clinical Features and Outcome of Subacute Thyroiditis in an Incidence Cohort: Olmsted County, Minnesota, Study

Division of Endocrinology, Diabetes, Metabolism, Nutrition and Internal Medicine (V.F., J.P.A., G.Z.E.F.), Division of Biostatistics (E.J.A.) and Division of Epidemiology (S.J.J.), Mayo Clinic, Rochester, Minnesota 55905

Address all correspondence and requests for reprints to: Vahab Fatourechi, M.D., Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905.

Subacute thyroiditis (SAT), or granulomatous thyroiditis, is an inflammatory thyroid condition associated with pain and systemic symptoms. Few community studies are available. We studied the 160 patients with SAT in Olmsted County, Minnesota, seen between January 1, 1960, and December 30, 1997. Subjects were identified through the medical diagnostic index of the Rochester Epidemiology Project. The overall age- and sex-adjusted incidence from 1960 through 1997 was 4.9 cases per 100,000/yr. In the most recent 28-yr period (1970–1997), 94 patients were identified. In this group, pain was the presenting symptom in 96%. SAT recurred in 4% of the patients 6–21 yr after the initial episode. Corticosteroid therapy was given to 36%. Early-onset hypothyroidism occurred both in patients receiving corticosteroid therapy (29%) and in those not receiving corticosteroid therapy (37%). At latest follow-up, significantly more patients who had received corticosteroid therapy had a diagnosis of hypothyroidism than the group without corticosteroid therapy (25% vs. 10%, P < 0.05; overall rate of hypothyroidism, 15%). Early transient hypothyroidism is common in SAT. Permanent hypothyroidism is less common, and only 15% of the patients are receiving T₄ therapy after 28 yr of follow-up. Symptomatic relief is achieved with corticosteroid therapy, but such therapy does not prevent early- and late-onset thyroid dysfunction.

This work was supported in part by the Richard Emslander Clinical Investigator Award and Scholarly Clinician Award of the Mayo Foundation and the U.S. Public Health Service, National Institutes of Health (AR-30582). These data were presented in part at the 74th Annual Meeting of the American Thyroid Association, November 9, 2001, Washington, D.C., and at the 84th Annual Meeting of The Endocrine Society, June 19, 2002, San Francisco, California.

Abbreviations: NSAID, Nonsteroidal anti-inflammatory drug; SAT, subacute thyroiditis.