A 32-year-old woman presents with a two-week history of painful anterior neck swelling, low-grade fever, and palpitations. ESR is 68 mm/hr. Free T4 is elevated and TSH is suppressed. Radioactive iodine uptake scan shows 2% uptake at 24 hours. Which is the most appropriate initial management?

• A Radioactive iodine ablation
• B Carbimazole
• C Total thyroidectomy
• D Aspirin or NSAIDs ✓

Explanation

Painful thyroid, elevated ESR, thyrotoxicosis with markedly suppressed RAIU point to subacute (de Quervain) thyroiditis, a self-limited inflammatory condition. NSAIDs or aspirin are first-line. Glucocorticoids are reserved for severe cases. Antithyroid drugs are ineffective because new hormone synthesis is not increased. Surgery and radioiodine are unnecessary.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.