Case history
Case history
A 40-year-old woman with no prior thyroid history presents with 7 days of fevers to 40°C (104°F), shaking, chills, myalgias, and pharyngitis. Over the last day, she has developed significant neck pain and discomfort that radiates to her ear and jaw. She notes a rapid heartbeat, palpitations, tremors, and feeling hot. She cannot eat or drink anything because it exacerbates the pain. She indicates that the pain is not in her pharynx but over her lower neck. She is mildly distressed and will not let you touch her neck because it hurts so much. On examination, she is tachycardic to 120 bpm, her extraocular muscles are intact, and her thyroid is enlarged, firm, and acutely tender to palpation. She is anxious and fidgety and has a fine tremor of her outstretched hands bilaterally.
Other presentations
Occasionally, the patient may present with a history of prior thyroid dysfunction, a firm goitre, and elevated serum erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) levels. They may have little or no neck pain. However, only a minority of patients exhibit the typical clinical manifestations for all 3 phases of subacute thyroiditis (thyrotoxicosis, hypothyroidism, and euthyroidism). Some patients have only the thyrotoxic phase, others may present exclusively in the hypothyroid phase, or solely with fever of unknown origin.[5]
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