A 29-year-old woman has a two-week history of anterior neck pain radiating to the jaw, palpitations, tremor, and low-grade fever. TSH is suppressed, free T4 mildly elevated, ESR 78 mm/hr, and radioiodine uptake at 24 hours is under 2 percent. What is the most appropriate management?
- A Radioiodine ablation of the thyroid gland
- B Total thyroidectomy once euthyroid
- C NSAIDs with a short course of propranolol, expecting spontaneous recovery ✓
- D Lifelong levothyroxine replacement starting now
Correct answer: C. NSAIDs with a short course of propranolol, expecting spontaneous recovery
Explanation
Painful neck with suppressed TSH, markedly low radioiodine uptake, and high ESR defines subacute (de Quervain) granulomatous thyroiditis, usually following a viral illness. Stored hormone leaks out, but the gland cannot take up iodine, hence the near-absent uptake that distinguishes it from Graves disease where uptake is high. It is self-limiting through thyrotoxic, hypothyroid, and recovery phases, so NSAIDs and beta blockade suffice; ablation, surgery, or permanent replacement are unwarranted.
Reference: Williams Textbook of Endocrinology, 14th ed.
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Written and medically reviewed by the StethoPrep medical team.