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Silent lymphocytic thyroiditis is a self-limited, subacute disorder occurring most commonly in women during the postpartum period. Symptoms are initially of hyperthyroidism, then hypothyroidism, and then generally recovery to the euthyroid state. Treatment of the hyperthyroid phase is with a β-blocker. If hypothyroidism is permanent, lifelong thyroxine supplementation is needed.

The term silent refers to the absence of thyroid tenderness in contrast with subacute thyroiditis, which usually causes thyroid tenderness. Silent lymphocytic thyroiditis causes most cases of postpartum thyroid dysfunction. It occurs in about 5 to 10% of postpartum women.

Thyroid biopsy reveals lymphocytic infiltration as in Hashimoto's thyroiditis but without lymphoid follicles and scarring. Thyroid peroxidase autoantibodies and, less commonly, antithyroglobulin antibodies are almost always positive during pregnancy and the postpartum period. Thus, this disorder would appear to be a variant of Hashimoto's thyroiditis (see Thyroid Disorders: Hashimoto's Thyroiditis).

Symptoms and Signs

The condition begins in the postpartum period, usually within 12 to 16 wk. Silent lymphocytic thyroiditis is characterized by a variable degree of painless thyroid enlargement with a hyperthyroid phase of several weeks, often followed by transient hypothyroidism due to depleted thyroid hormone stores but usually eventual recovery to the euthyroid state (as noted for painful subacute thyroiditis). The hyperthyroid phase is self-limited and may be brief or overlooked. Many women with this disorder are diagnosed when they become hypothyroid, which occasionally is permanent.

Diagnosis

Silent lymphocytic thyroiditis is frequently undiagnosed. Suspicion of the diagnosis generally depends on clinical findings, typically once hypothyroidism has occurred. Eye signs and pretibial myxedema do not occur.

Thyroid function test results vary depending on the phase of illness. Initially, serum T₄ and T₃ are elevated and TSH is suppressed. In the hypothyroid phase, these findings are reversed. WBC count and ESR are normal. Needle biopsy provides definitive diagnosis but is usually unnecessary.

Treatment

Because silent lymphocytic thyroiditis lasts only a few months, treatment is conservative, usually requiring only a β-blocker (eg, propranolol Some Trade Names
INDERAL
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) during the hyperthyroid phase (see Thyroid Disorders: Treatment). Antithyroid drugs, surgery, and radioiodine therapy are contraindicated. Thyroid hormone replacement may be required during the hypothyroid phase. Most patients recover normal thyroid function, although some remain permanently hypothyroid. Therefore, thyroid function should be reevaluated after 9 to 12 mo of thyroxine therapy; replacement is stopped for 5 wk and TSH remeasured. This disorder usually recurs after subsequent pregnancies.

Last full review/revision June 2008 by Jerome M. Hershman, MD

Content last modified June 2008