De Quervain's thyroiditis: Surgical experience

Objective: To review a 35-year experience with management of de Quervain's thyroiditis (dQT), an uncommon inflammatory process of the thyroid gland that is usually treated medically and seldom necessitates surgical intervention. Methods: A retrospective review was performed of medical records of patients with dQT treated surgically at a single institution between 1966 and 2000. The study group consisted of 11 women and 6 men (mean age, 50 years; range, 23 to 66). All pathology specimens were reviewed. Results: Of the 17 study patients, 14 had surgical treatment before 1980. Typical symptoms of dQT, including pain and tenderness of the thyroid gland, occurred in eight patients, and two had dysphagia from an enlarged thyroid gland. Seven patients were asymptomatic. The indications for operation were a clinically indeterminate thyroid nodule (N = 14), dysphagia (N = 2), and hyperthyroidism with nodular goiter (N = 1). Fine-needle aspiration biopsy (FNAB) was performed in only two patients; biopsy findings were suspicious for a malignant lesion in one patient, and nondiagnostic in the other patient. Thyroid function tests (N = 14) revealed that 12 patients were euthyroid and 2 had hyperthyroidism. Surgical treatment consisted of unilateral lobectomy in 4 patients, near-total thyroidectomy in 12, and total thyroidectomy in 1. Temporary vocal cord palsy and temporary hypocalcemia occurred in one patient each. Fourteen patients (mean follow-up, 204 months) required long-term thyroid replacement therapy. No patient required further thyroid surgical intervention or had further thyroid disease. Conclusion: Although surgical intervention is not the primary treatment for dQT, when resection is performed it can be done safely and with low associated morbidity. In the modern era, with routine use of FNAB, fewer patients with this rare entity will require surgical exploration. Patients with atypical features and ones with euthyroidism are more likely candidates than others for surgical intervention.