Snapshot A 40-year-old man presents to his primary care physician for palpitations. He had previously presented to the emergency room for similar reasons, when his EKG was found to be tachycardic but otherwise regular rhythm. He was sent home after intravenous hydration at that time. He reports that ever since an upper respiratory infection a few months ago, he has lost weight, felt fatigued, and experienced intermittent palpitations. He has no significant medical history. He also reports having increasing jaw and anterior neck pain. On physical exam, his thyroid is very tender to palpation. No goiter was palpated. His T3 and T4 levels come back elevated, and his physician prescribes him 2 medications for this disease with reassurance that symptoms usually resolve over time. Introduction Clinical definition a granulomatous autoimmune disease of the thyroid that causes hyperthyroidism that may be followed by a hypothyroid phase also known as de Quervain or granulomatous thyroiditis Epidemiology demographics women > men adults risk factors viral infections human leukocyte antigen-B35 family history Pathogenesis mechanism transient inflammation of the thyroid gland causes release of ↑ T3 and T4 results from injury of thyroid follicles Associated conditions medical conditions and comorbidities Prognosis patients will generally return to normal thyroid function within a year Presentation Symptoms anterior neck and jaw pain de Quervain causes pain flu-like prodrome fever, malaise, and fatigue 3 phases hyperthyroid phase nervousness, tachycardia, and palpitations sweating resting tremor hyperactive reflexes hypothyroid phase increased relaxation of deep tendon reflexes euthyroid phase Studies Diagnostic testing studies T3/T4 ↑ during hyperthyroid phase ↓ during hypothyroid phase thyroid stimulating hormone (TSH) ↓ during hyperthyroid phase ↑ during hypothyroid phase ↓ radioactive iodine uptake i.e., gold standard for diagnosis ↑ inflammatory markers C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) biopsy rarely needed but will show granulomatous inflammation Differential Postpartum thyroidits distinguishing factor thyroiditis after childbirth painless thyroid Silent thyroiditis distinguishing factor painless thyroid hyperthyroidism followed by transient hypothyroidism Riedel thyroiditis distinguishing factor hard and painless thyroid Treatment Management approach because this disease is self-limited, management of symptoms is the mainstay treatment First-line nonsteroidal anti-inflammatory drugs (NSAIDs) indication mild symptoms beta-blockers indication given with anti-inflammatory agents Second-line corticosteroids indication symptoms of thyrotoxicosis refractory to NSAIDs Complications Recurrence Permanent hypothyroidism
QUESTIONS 1 of 2 1 2 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M2.EC.14.67) A 45-year-old woman presents to the emergency department with a 1-week history of a painful mass in her neck. The patient reports the mass has slowly been enlarging over this time span and has become more painful to the touch. She also reports night sweats, weight loss, and diarrhea. Review of systems is notable only for a minor cold a few weeks ago. Her temperature is 100°F (37.8°C), blood pressure is 122/80 mmHg, pulse is 160/min, respirations are 19/min, and oxygen saturation is 100% on room air. Physical exam is notable for a diffusely enlarged thyroid that is tender to the touch. An ECG is performed as seen in Figure A. Which of the following is the most likely diagnosis? QID: 103008 FIGURES: A Type & Select Correct Answer 1 Graves disease 100% (7/7) 2 Hashimoto thyroiditis 0% (0/7) 3 Riedel thyroiditis 0% (0/7) 4 Silent thyroiditis 0% (0/7) 5 Subacute granulomatous thyroiditis 0% (0/7) M 6 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 5 Review Tested Concept Review Full Topic