Prev

Subacute granulomatous de Quervain's thyroiditis - Case 41.

Nodular goiter

Next

First examination (1st and 4th rows of images):

Clinical presentation: a 34-year-old woman requested a second opinion. She had an upper airways infection for 3 months. Six weeks later her thyroid became painful. On evaluation a hyperthyroidism was diagnosed and methimazole therapy was started for 3 weeks. Although her neck complaints have decreased she had persistent neck tenderness occasionally pain. erred for an evaluation of neck complaints. She noticed tenderness in the left side of the neck for 3 weeks. One week prior to the examination, pain appeared in the right thyroid. Her body temperature was normal as was the erythrocyte sedimentation rate and CRP, 14 mm/H and 4.1 mg/L (normal value 0-4.8), respectively.

Palpation: both lobes were painful and hard.

Laboratory tests: hyperthyroidism on daily 30 mg methimazole with TSH 0.001 mIU/L and FT4 62.5 pM/L, aTPO 2 U/mL, CRP 41.6 mg/L (normal value 0-4.8).

Ultrasonography: the thyroids were echonormal. There were multiple hypoechogenic areas with ill-defined borders in both lobes. According to the hypoechogenic areas, the vascularization was decreased.

Aspiration cytology: was performed from the right thyroid and resulted in subacute, granulomatous, de Quervain's thyroiditis.

Steroid therapy was suggested.

Follow-up examination 3 months later (2nd row of images):

Clinical presentation: the complaints of the patient ceased within 24 hours of steroid administration. One week before present examination the left thyroid became tender.

Palpation: no abnormality. The left side of the neck was tender on palpation.

Functional state: euthyroidism with TSH 3.34 mIU/L, FT4 12.9 pM/L. CRP was 2.5 mg/L.

Ultrasonography: the proportion of hypoechogenic areas decreased substantially as did the size of the thyroid. The vascularization became normal.

We suggested non-steroid anti inflammatory drug. The complaints of the patient ceased within a several days.

Follow-up examination 6 months later (3rd row of images):

Clinical presentation: the patient had no complaints.

Palpation: no abnormality. The left side of the neck was tender on palpation.

Functional state: euthyroidism with TSH 1.98 mIU/L. CRP was 1.1 mg/L.

Ultrasonography: the thyroids was echonormal and contained small hypoechogenic areas. The vascularization was average.

 

 

 

mask