Subacute thyroiditis (de Quervain's) is possibly caused by a viral infection of the thyroid gland. It has a seasonal and geographic distribution common to infections with mumps virus, coxsackievirus, and echo virus. Patients with this disorder usually have an acute phase of thyroiditis in which the gland may be painful and antithyroid antibodies may be present. At this time, patients are thyrotoxic, with an elevated serum T4 and decreased radioiodine uptake.
Progressive euthyroid and hypothyroid periods of 4-8 weeks may follow before thyroid functions finally normalize. Subacute thyroiditis causes a rapidly enlarging thyroid gland and signs of thyroid dysfunction are typically seen. It has an acute course and is often associated with pain and tenderness in the area of the gland. It is also accompanied by an elevated erythrocyte sedimentation rate. It can cause "low-uptake" toxicosis, in that they can produce elevated serum levels of thyroid hormones in the face of low to normal levels of thyroid hormones in the face of low to normal levels of radioactive iodine uptake.