A 30-year-old woman presents with anterior neck pain radiating to the jaw, fever and a tender diffusely enlarged thyroid. ESR is 85 mm/hr, free T4 is mildly elevated, TSH is suppressed, and radioiodine uptake at 24 hours is 2 percent. What is the correct statement about this condition?
- A It is usually self-limiting and treated with NSAIDs or steroids for pain ✓
- B It requires lifelong levothyroxine replacement in most patients
- C It is caused by an activating TSH receptor mutation and treated with antithyroid drugs
- D Early thyroidectomy is indicated to relieve compression
Correct answer: A. It is usually self-limiting and treated with NSAIDs or steroids for pain
Explanation
This is subacute granulomatous (de Quervain) thyroiditis, a post-viral condition presenting with a painful tender goitre, high ESR and thyrotoxicosis with suppressed radioiodine uptake because destroyed follicles release preformed hormone and cannot trap iodine. It runs a course of thyrotoxicosis, then hypothyroidism, then recovery, and permanent hypothyroidism is uncommon, so lifelong replacement is not routine. Antithyroid drugs are useless since the gland is not overproducing hormone.
Reference: Williams Textbook of Endocrinology, 13th ed.
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Written and medically reviewed by the StethoPrep medical team.