A woman presents with an acute, painful thyroid swelling, malaise, and fever two weeks after a sore throat. What is the most likely diagnosis?
A. Acute suppurative thyroiditis
B. Sub-acute thyroiditis (De Quervain's thyroiditis)
C. Graves' disease
D. Follicular thyroid carcinoma
The most likely diagnosis in this case is B. Sub-acute thyroiditis (De Quervain's thyroiditis). Here's why:
Clinical presentation:
Timeline: The development of a painful thyroid swelling two weeks after a sore throat is a classic presentation of sub-acute thyroiditis. The sore throat suggests a recent viral infection, which is thought to trigger the autoimmune reaction in this condition.
Symptoms: Painful thyroid swelling, malaise, and fever are all typical symptoms of sub-acute thyroiditis.
Comparison with other options:
Acute suppurative thyroiditis: This is a rare bacterial infection of the thyroid gland that typically presents with severe symptoms like abscess formation, high fever, and difficulty swallowing. The absence of these features makes it less likely in this case.
Graves' disease: This is an autoimmune disorder that causes hyperthyroidism. While it can present with a swollen thyroid, it usually doesn't cause significant pain, and other symptoms like anxiety, weight loss, tremors, and bulging eyes are typically present.
Follicular thyroid carcinoma: This is a type of thyroid cancer that usually presents with a slow-growing, painless nodule in the thyroid gland. The acute presentation and lack of a specific thyroid nodule make it less likely in this case.
Additional investigations:
While the clinical presentation strongly suggests sub-acute thyroiditis, further investigations would be necessary for a definitive diagnosis. These may include:
Thyroid function tests: These may initially show thyrotoxicosis (low TSH, high T3 and T4 levels) followed by a hypothyroid phase (high TSH, low T3 and T4 levels).
Thyroid ultrasound: This may show diffuse hypoechogenicity of the thyroid gland.
Treatment:
Treatment for sub-acute thyroiditis focuses on managing symptoms and allowing the inflammation to resolve on its own. This may include:
Pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen can help relieve pain and fever.
Corticosteroids: In severe cases, corticosteroids may be used to reduce inflammation.
Beta-blockers: These medications can help manage symptoms of thyrotoxicosis, such as anxiety and tremors.
Prognosis:
Sub-acute thyroiditis is usually a self-limiting condition that resolves within a few months. However, it can recur in some cases.
0 Comments