Painful subacute thyroiditis

2021-07-26 11:55 PM

Thyroiditis usually causes changes in thyroid function from hyperthyroidism (due to destructive damage to the gland, euthyroidism, or hypothyroidism due to hormone depletion).

Thyroiditis is an acute or chronic inflammation of the thyroid gland of various etiologies. Thyroiditis usually causes changes in thyroid function from hyperthyroidism (due to destructive damage to the gland, euthyroidism, or hypothyroidism due to hormone depletion). The changes depend on the stage of the disease. To distinguish the types of thyroiditis should be based on clinical symptoms, speed of disease onset, and especially neck pain.

Definite diagnosis

Clinical

Onset: body aches, sore throat, low-grade fever, then possibly a high fever.

Neck pain: the thyroid gland is enlarged, tender to the touch, very painful, usually starting from one side then spreading to the other, spreading to the ears, all over the neck, can be difficult to swallow.

Symptoms of thyrotoxicosis: moderate and mild hyperthyroidism.

Subclinical

Blood count

white blood cells normal or increased, erythrocyte sedimentation rate increased, protein c-reactive increased.

Thyroid screening:

Commonly, hormone FT4, FT3 increased slightly or moderately, TSH decreased low.

Anti-thyroid antibodies: not increased.

I 131 concentration measurement: very low I 131 concentration, 123l, 99mTc.

Ultrasound: hypoechoic thyroid, few blood vessels.

Differential diagnosis

Cases of neck pain

Thyroiditis caused by pyogenic bacteria (acute thyroiditis): obvious infection, high fever, elevated white blood cells.

Hemorrhage in thyroid cyst: localized pain, unilateral, asymptomatic infection, thyroid ultrasound showing the large cyst.

Need to differentiate thyrotoxicosis in subacute thyroiditis with Graves' disease: enlarged thyroid with a murmur, no pain when pressing. There may be ocular symptoms or anterior tibial myxedema. Concentration I 131 is high.

Treatment is mainly symptomatic treatment

Pain relief: common pain relievers such as Paracetamol are used 2-4 times a day or non-steroidal anti-inflammatory drugs in common cases. In severe cases or unresponsive to analgesics, glucocorticoids (prednisone 20-40mg/day) can be used, gradually reducing the dose by 5mg every 1-2 weeks and stopping the drug after 4-6 weeks.

Reduce symptoms of hyperthyroidism: if symptoms of hyperthyroidism are obvious, symptoms can be reduced by beta-blockers such as propranolol 40mg/day or atenolol 50mg/day... until FT4 test returns to normal, it should be noted. Contraindications of the drug such as bronchial asthma, chronic obstructive pulmonary disease, severe heart failure, ...

Stage of hypothyroidism: usually transient, does not require treatment. If hypothyroidism persists, thyroid hormone replacement therapy with L-thyroxine 50-100 μg/day may be used for several weeks or months.