Can a patient with De Quervain's thyroiditis experience fever?

Can Patients with De Quervain's Thyroiditis Experience Fever?

Yes, fever is a recognized clinical feature of De Quervain's thyroiditis and occurs in a substantial proportion of patients, though it is not universally present.

Clinical Presentation of Fever in De Quervain's Thyroiditis

Fever is documented as part of the diagnostic criteria for De Quervain's thyroiditis, appearing alongside the classic triad of painful thyroid enlargement, elevated inflammatory markers, and decreased thyroid uptake on scintigraphy 1, 2. The fever typically manifests as:

• Low-grade to moderate fever that accompanies the acute inflammatory phase of the disease 3
• Systemic symptoms including the fever, which can cause significant discomfort or even complete prostration for weeks to months if left untreated 4
• Temporal relationship with the thyroid pain and tenderness, usually appearing approximately two weeks after an upper respiratory viral infection 2

Distinguishing Features

The fever in De Quervain's thyroiditis presents with characteristic accompanying findings that help differentiate it from other causes:

• Painful thyroid enlargement with exquisite tenderness on palpation, with pain radiating to the mandible and/or ears 2, 3
• Markedly elevated erythrocyte sedimentation rate (ESR), which is a hallmark diagnostic feature 1, 2, 3
• Normal or slightly elevated leukocyte count and C-reactive protein, distinguishing it from acute bacterial thyroiditis 2
• Transient thyrotoxicosis present in approximately 50% of cases during the early phase, which may contribute to systemic symptoms 1

Clinical Context and Phases

The fever typically occurs during the initial destructive inflammatory phase of the disease, which follows a predictable four-phase natural history 2:

1. Initial hyperthyroid phase with inflammation (where fever is most prominent)
2. Euthyroid phase
3. Transient hypothyroid phase
4. Recovery to normal thyroid function

Management Implications

Recognition of fever as part of De Quervain's thyroiditis is clinically important because:

• Symptomatic treatment with analgesics or NSAIDs addresses both the fever and pain in mild to moderate cases 1, 4
• Glucocorticoid therapy (prednisone 40-50 mg daily initially) is indicated for severely ill patients with significant fever and systemic symptoms, typically resulting in rapid symptom resolution within 24-48 hours 4, 3
• Fever resolution serves as a clinical marker of treatment response, though ESR may not reliably track with clinical improvement during steroid taper 3

Important Caveats

• The absence of fever does not exclude De Quervain's thyroiditis, as not all patients manifest fever 2
• Fever in the context of thyroid disease requires careful evaluation to exclude other serious conditions, particularly acute suppurative thyroiditis (which presents with higher fever, leukocytosis with left shift, and requires antibiotics or drainage) 2
• The disease is extremely rare in children but when it occurs, fever is similarly present as part of the clinical picture 1, 5