Review Question - QID 103008

This patient is presenting after an infection with painful enlargement of the thyroid, diarrhea, sweating, and weight loss which is consistent with subacute granulomatous thyroiditis (also called de Quervain thyroiditis).

Subacute granulomatous thyroiditis is the most common cause of thyroid pain and has a greater incidence in women. The etiology is often post-infectious and viral in origin. Early in the course of the disease, the patient may be hyperthyroid as follicular cells are damaged and release large amounts of T3/T4. This is often followed by a period of hypothyroidism as T3/T4 is depleted, and eventually euthyroidism within the oncoming months. A differentiating feature of this condition is the enlarged and tender thyroid gland. Treatment is only NSAIDs and symptom control since this condition resolves on its own.

Figure A is an ECG demonstrating a narrow complex tachycardia suggestive of supraventricular tachycardia secondary to hyperthyroidism.

Incorrect Answers:
Answer 1: Graves disease presents with signs of hyperthyroidism, exophthalmos, pretibial myxedema, and occasionally thyroid bruits. Graves is generally not painful and is not acutely precipitated by an infection.

Answer 2: Hashimoto thyroiditis presents with a transient phase of hyperthyroidism (which is often undetected) followed by hypothyroidism (which is permanent). Typically, the hyperthyroid phase presents with a painless thyroid.

Answer 3: Riedel thyroiditis presents as a rock-hard, non-tender thyroid in the setting of hypothyroidism.

Answer 4: Silent thyroiditis presents with a transient hyperthyroid phase followed by a transient hypothyroid phase. The difference between this condition and subacute thyroiditis is that the thyroid is nontender in this condition.

Bullet Summary:
Subacute thyroiditis presents with an enlarged and tender thyroid with symptoms of hyperthyroidism.