A 30-year-old woman presents with severe anterior neck pain radiating to the jaw after a recent upper respiratory infection. She is thyrotoxic with free T4 elevated and TSH suppressed. Technetium thyroid scintigraphy shows virtually absent tracer uptake. Which statement is correct regarding her condition?
- A The condition is usually self-limiting and treated with NSAIDs or steroids ✓
- B High-dose antithyroid drugs are the mainstay of treatment
- C She requires radioactive iodine ablation once pain settles
- D Urgent thyroidectomy is indicated because of malignancy risk
Correct answer: A. The condition is usually self-limiting and treated with NSAIDs or steroids
Explanation
De Quervain subacute granulomatous thyroiditis follows viral illness, presents with painful goitre, raised ESR and thyrotoxicosis from destructive release of preformed hormone. Because follicles are destroyed, radioiodine uptake is characteristically near zero, which separates it from Graves disease (diffusely increased uptake) and toxic nodular disease. Antithyroid drugs are ineffective since there is no excess synthesis. The course is self-limiting with NSAIDs, short-course corticosteroids and beta blockers, followed often by transient hypothyroidism.
Reference: Harrison Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.