The classical course of subacute thyroiditis was described by Volpé et al1: following a viral prodrome, patients experience thyroidal pain and swelling, and large amounts of thyroxine and triiodothyronine are released from the gland, resulting in thyrotoxicosis that lasts for several months. The high levels of thyroid hormone, which suppress thyroid-stimulating hormone (TSH), and the inability of the damaged gland to trap iodine lead to a decreased (1% to 2%) radioactive iodine uptake (RAIU). Following the thyrotoxicosis, euthyroidism ensues, in which the levels of triiodothyronine and thyroxine return to normal and the tender goiter resolves. During euthyroidism, the levels of TSH and the RAIU return to normal or may even become transiently elevated. Most patients do not progress beyond this phase, but 25% have transient hypothyroidism lasting two to six months. Almost all of these patients later recover, and indexes of thyroid function gradually return to normal.
Dorfman SG, Young RL, Nusynowitz ML. Thyroiditis and Thyrotoxicosis. JAMA. 1978;240(14):1520–1521. doi:10.1001/jama.1978.03290140062031
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