Abstract
BackgroundA diagnosis of subacute thyroiditis is readily considered when patients present with a particular set of typical clinical characteristics. Subacute thyroiditis sometimes presents as a solitary cold nodule; however, the presence of a hot nodule in patients with subacute thyroiditis is exceedingly rare.Case presentationHere, the case of a 57-year-old woman complaining of pain in the left neck and fatigue for two weeks is presented. Physical examination revealed a painful and tender nodule with a diameter of approximately 1.5 cm in the left neck, although all laboratory tests, including white blood cell count, neutrophil percentage, erythrocyte sedimentation rate (ESR), thyroid function, and thyroglobin levels, were normal. A neck ultrasound revealed a hypoechoic mass (1.5 × 0.8 cm) in the left thyroid, and thyroid scintigraphy of the left thyroid with Technetium-99 m (99 m-Tc) demonstrated a focal accumulation of radiotracer. Furthermore, fine-needle aspiration biopsy from the nodule revealed the presence of multinuclear giant cells. The patient was well; there was no cervical mass detected upon palpation following two months of prednisone treatment, and follow-up ultrasound screening and scintigraphy demonstrated the disappearance of the nodule.ConclusionThis case, presenting with a localized painful hot nodule, normal thyroid function, normal ESR, and normal serum thyroglobulin levels, is a rare case of subacute thyroiditis, which should be considered during differential diagnosis.
Highlights
A diagnosis of subacute thyroiditis is readily considered when patients present with a particular set of typical clinical characteristics
A patient with subacute thyroiditis, who presented with a solitary painful thyroid nodule in the absence of typical laboratory test characteristics that would suggest subacute thyroiditis and whose 99 m-Tc thyroid scan revealed a hot nodule in the left lobe of thyroid, is described
In addition to the typical clinical signs, characteristic ultrasound findings of subacute thyroiditis include the presence of an ill-defined hypoechoic area with a nonhomogeneous pattern [8]
Summary
Known as de Quervain’s thyroiditis, giant-cell thyroiditis, or subacute granulomatous thyroiditis, is a spontaneously remitting inflammatory disease of the thyroid gland [1,2]. Patients with subacute thyroiditis usually have a history of antecedent viral infection and subsequently suffer from neck pain, thyroid tenderness, fever, and fatigue. A diagnosis of subacute thyroiditis is usually self-evident and can be made based on patient history, physical and laboratory findings, and the clinical course of the disease. Case presentation A 57-year-old woman with no history of thyroid disease visited our outpatient endocrine clinic on July 27, 2012 Two weeks prior, she had developed symptoms of pain in the left neck and fatigue. Physical examination revealed a focal nodule of the left thyroid lobe that had a diameter of approximately 1.5 cm without local redness or lymph node enlargement, which was painful and tender upon examination. Fine-needle aspiration biopsy from the nodule in the lower left lobe revealed multinuclear giant cells consistent with subacute thyroiditis (Figure 2). Repeated ultrasound screening revealed a disappearance of the hypoechoic nodule (Figure 3A) and follow-up scintigraphy analysis found the thyroid exhibited an even distribution of radionuclide in both lobes (Figure 3B)
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