Snapshot A 34-year-old woman presents with a pain in the neck when with a mass. These symptoms started following a viral upper respiratory infection she had last week. On exam her thyroid is enlarged and tender to palpation. A biopsy is shown. (subacute granulomatous thyroiditis) Introduction Self-limiting hypothyroidism following a viral infection (URI) early on may be hyperthyroid but later becomes hypothyroid (similar to Hashimoto's) Differentiate from subacute lymphocytic thyroiditis typically presents with a transient thyrotoxic phase of 2-5 months may be followed by a self-limited hypothyroid disease phase thyroid is not painful silent thyroiditis presents with painless hyperthyroidisim followed by transient hypothyroidism Presentation Physical exam jaw pain very tender thyroid gland subacute lymphocytic thyroiditis is painless (vs painful subacute granulomatous thyroiditis) no cervical adenopathy Evaluation Labs ↑ ESR Histology granulomatous inflammation 123I uptake decreased Treatment Medical NSAIDs and beta blockers symptomatic relief Prognosis, Prevention, and Complications Patients recover without treatment Rare to progress to permanent hypothyroidism