Although formerly thought to be a constant feature of the disease, pain is sometimes absent. Tenderness on careful palpation is almost universal, but occasional instances of nontender thyroiditis have been described. Usually, the thyroid is diffusely enlarged. Although at the outset only one side may be palpable and tender, in most patients the entire gland ultimately becomes abnormal. Local adenopathy is not impressive.
Subacute thyroiditis is self-limited, but the course is extraordinarily variable.
As a result, it has been difficult to demonstrate either the need for treatment or the best approach. For most patients, salicylates and time are adequate. In elderly patients or those with underlying cardiac disease, adjunctive use of propranolol may offset the putative risk of triiodothyronine. An alternative treatment is prednisone in full anti-inflammatory doses. Subacute thyroiditis does not induce permanent hypothyroidism.