A 33-year-old woman presents with anterior neck pain radiating to the jaw, fever, palpitations, and tremor. TSH is suppressed at 0.01 mIU/L, free T4 is 3.1 ng/dL, ESR is 68 mm/hr, and 99mTc thyroid uptake is 0.8% (normal 15 to 25%). What is the most appropriate initial management?
- A Carbimazole and propranolol
- B Radioactive iodine therapy
- C Propranolol and an NSAID such as naproxen ✓
- D Levothyroxine replacement
Correct answer: C. Propranolol and an NSAID such as naproxen
Explanation
Painful neck swelling, high ESR, thyrotoxicosis, and near-absent radioiodine uptake are classic for subacute (de Quervain) granulomatous thyroiditis. The thyrotoxicosis results from destructive hormone release, so thionamides like carbimazole are ineffective, and radioiodine will not be taken up by the inflamed gland. Treatment is symptomatic: beta blockers for adrenergic symptoms and NSAIDs or corticosteroids for pain, with spontaneous recovery expected.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.