Effects of prednisone combined with indomethacin in the treatment of patients with subacute thyroiditis / 中国基层医药

Objective@#To investigate the application effects of prednisone combined with indomethacin in the treatment of patients with subacute thyroiditis.@*Methods@#From January 2015 to January 2017, 140 patients with subacute thyroiditis in Yantai Mountain Hospitalwere chosen in this research, and they were randomly divided into control group and research group according to the digital table, with 70 cases in each group.Both two groups were treated with prednisone, the research group was given indomethacin on this basis.The time of fever extinction, the time of goiter subside, the time of thyroid ache extinction, ESR, thyroid hormone, adverse reaction and recurrence of the two groups were compared.@*Results@#The time of fever extinction, the time of goiter subside, the time of thyroid ache extinction of the research group were (1.65±0.89)d, (2.54±0.92)d, (7.63±1.57)d, which were all shorter than those of the control group [(2.07±1.03)d, (2.96±1.35)d, (8.45±1.84)d], the differences were statistically significant(t=2.581, 2.151, 2.836, all P<0.05). After treatmnet, ESR, TSH, FT3, FT4 of the research group were (9.35±4.17)mm/h, (2.53±2.07)μU/L, (5.37±2.81)pmol/L, (14.26±2.54)pmol/L, respectively, which of the control group were (9.67±4.26)mm/h, (2.45±1.84)μU/L, (5.49±2.23)pmol/L, (14.85±3.27)pmol/L, respectively, there were no statistically significant differences between the two groups (all P>0.05). There were 6 cases(8.57%) occurred adverse reaction in the research group, and 15 cases(21.42%) in the control group, the difference was statistically significant(χ2=4.538, P<0.05). All the patients were followed up for 6 months, 6 cases(8.57%) of recrudescence occurred in research group, 7 cases(10.00%) in the control group, the difference was not statistically significant (χ2=0.085, P>0.05).@*Conclusion@#Prednisone combined with indomethacin has similar effects as prednisone in the treatment of patients with subacute thyroiditis, but the combination has faster improvement of improving fever, pain, swelling, etc, and with better safety.

Application value of tissue dispersion quantitative analysis technique in different stages of SAT / 中华超声影像学杂志

Objective To investigate the application value of the ultrasonic elastic tissue dispersion quantitative analysis technique in different stages of subacute thyroiditis (SAT).Methods One hundred and forty-four SAT lesions detected from 81 patients were enrolled in the patient group.They were further divided into three subgroups,including acute group (group Ⅰ),medium group (group Ⅱ) and recovery group (group Ⅲ).Another 59 healthy volunteers were collected as control group.All the participants accepted conventional ultrasound and elastographic examinations.Eleven parameters were obtained by the tissue dispersion quantitative analysis software.These parameters were compared between groups and among subgroups by ANOVA.The correlation between all the parameters and the course of SAT were analyzed by Spearman and Multiple linear regression methods.Results Between groups and among subgroups,the complexity (COMP) and correlation (CORR) were not statistically different(all P ＞0.05).Differences of kurtosis (KURT) and angular secon moment (ASM) among the three subgroups were not significant (all P ＞0.05).Differences between groups and among subgroups were significantly different among the value of all the other seven indexes (all P ＜0.01).Moreover,they were all correlated with the clinical staging,with the highest coefficient in area ration of low-strain region (％ AREA)(r =-0.881).Regression model was constructed and only ％ AREA was selected into the regression equation.ROC curves were constructed to estimate the clinic value of ％ AREA in staging patients of SAT,the areas under ROC curves were0.986(group Ⅰ vs group Ⅱ-Ⅲ) and 0.988 (group Ⅰ-Ⅱ vs group Ⅲ[) for ％AREA,respectively.Conclusions The tissue dispersion quantitative analysis technique is helpful in estimating the stiffness of thyroid in patients with SAT.

A retrospective analysis of epidemiological and clinical features of 121 patients with subacute thyroiditis / 中华地方病学杂志

Objective To summarize and analyze the epidemiological and clinical characteristics of patients with subacute thyroiditis (SAT),so as to provide a basis for prevention and treatment of the disease.Methods The epidemiological and clinical datas of 121 SAT patients,who were treated at the Shandong Provincial Institute for Endemic Disease Prevention and Control in 2015,were collected.The SAT patient's age,sex,lived in urban or rural areas,occupation and time of onset distributions were analyzed retrospectively.According to the clinical manifestations,the SAT patients were divided into types Ⅰ (mild/nodule type),Ⅱ (medium/normal),Ⅲ (severe/hyperthyroidism),and Ⅳ (delay),and clinical manifestations,auxiliary examination findings,treatment and outcome were summarized.Results Average age of the 121 cases of SAT patients was 41.36 years old,the youngest was 10 years old and the oldest was 76 years old.Most of the patients were 30-＜ 50 years old,which was accounted for 55.37％ (67/121).Most of the patients were female,which was accounted for 90.08％ (109/121).Most of the patients lived in rural areas,which was accounted for 59.50％ (72/121).Majority of the SAT patients were farmers,which was accounted for 43.80％ (53/121).Most onset of the disease was in November,accounted for 19.83％ (24/121),and the least was in June,accounted for 2.48％ (3/121),the peak of the incidence of SAT lied in autumn,and it was sporadic in the rest of the year.From the clinical classification,the mild type (61) and the medium type (46) were the largest part,a total of 107 cases,accounted for 88.43％ (107/121);while the severe type had 5 cases,accounted for 4.13％ (5/121);the delay type had 9 cases,accounted for 7.44％ (9/121).The clinical manifestations were as follows:anterior neck discomfort was 109 cases,accounted for 90.08％ (109/121);sore throat was 93 cases,accounted for 76.86％ (93/121).Auxiliary examination findings were as follows:thyroid iodine taken rate reduced in 121 cases,accounted for 100.00％ (121/121);thyroid nodule 96 cases,accounted for 79.34％ (96/ 121);total number of white blood cells increased in 52 cases,accounted for 42.98％ (52/121);neutrophil increased in 61 cases,accounted for 50.41％ (61/121);blood sedimentation significantly speed up in 49 cases,accounted for 40.50％ (49/121).All of the 121 patients were cured.Conclusions Majority of the patients are female,young aduhs and farmers.The peak of the incidence of SAT lies in autumn.The proportion of mild,medium type is the highest,we suggest this disease should be early diagnosis and treatment.

Tiroiditis subaguda con ausencia de captación cintigráfica unilateral inicial / Subacute thyroiditis with initial unilateralabsence of scintigraphic uptake

Subacute thyroiditis is a transient inflammatory process of the thyroid gland and the most common cause of painful thyroiditis. It usually involves the whole thyroid. We present a clinical case of a 45 years old woman developing tachycardia, fever and painful sensation in the left anterior cervical region after an upper respiratory tract infection. In addition the patient presented an enlarged and painful left thyroid lobe. Laboratory analysis demonstrated elevated acute phase reactants, high T4 levels and suppressed thyrotropin with absence of antithyroid antibodies. Thyroid scintigram showed an absent left radioactive iodine uptake. One month later the patient started with malaise, fatigue with an enlarged painful right thyroid lobe. A new scintigram showed complete absence of radioactive iodine uptake. A course of prednisone was initiated with excellent clinical response. Four months later the patient was asymptomatic with normal thyroid function.

A Case of Graves' Disease Occurring after Subacute Thyroiditis / 대한내과학회지

Graves' disease following subacute thyroiditis is uncommon. Some patients in these cases showed positive for thyroid antibody only transiently in the resolving phase. However, Graves' disease can rarely be caused by the presence of antibodies after subacute thyroiditis, although the pathophysiology of this is unclear. A 40-year-old woman presented with anterior neck pain and swallowing difficulty. Thyroid function testing showed reduced thyroid-stimulating hormone (TSH) and elevated free thyroxine levels. A thyroid scan revealed decreased uptake in the bilateral thyroid gland. The patient was initially diagnosed with subacute thyroiditis and treated with steroids. Five months later, thyroid function testing showed recurrent hyperthyroidism with positive conversion of TSH receptor antibody, indicating Graves' disease. Since then, she needed the long-term methimazole treatment. In summary, we herein report a case of Graves' disease occurring after subacute thyroiditis.

Approach to the patient with Graves' disease and concomitant subacute thyroiditis: diagnosis and treatment / 中华内分泌代谢杂志

Subacute thyroiditis can cause destruction of thyroid follicles and subsequent transient thyrotoxicosis.In cases of simultaneous occurrences of subacute thyroiditis and Graves' disease,the former may be missed and thus may further exacerbate thyrotoxicosis.Herein,we report in detail a case with abrupt onset of thyrotoxic heart disease when taking anti-thyroid medications,in order to call attention to the diagnosis and treatment of concomitant Graves' disease and subacute thyroiditis.

Clinical treatment of 100 patients with subacute thyroiditis / 中华全科医师杂志

A total of 100 patients with subacute thyroiditis hospitalized from January 2011 to October 2012 were recruited.Each received glucocorticoid treatment for 8 weeks and there was a 2-month follow-up period after drug withdrawal.After treatment,the short-term recurrence rate was 34％ (34/100).If thyroid ultrasound was abnormal,the recurrence rate was 52％ (30/58).And it was significantly higher than 10％ recurrence rate for those with normal thyroid ultrasound (4/42,x2 =9.67,P ＜ 0.01).The recurrence rate of different erythrocyte sedimentation rate groups of 40-100 mm/1 h and ＞ 100 mm/1 h was 37％ (22/60) and 30％ (12/40) respectively (P ＞ 0.05).

Effect of operation in the treatment of subacute thyroiditis / 中国基层医药

Objective To explore the curative effects of operation in treatment of subacute thyroiditis.Methods The clinical data of 87 patients with subacute thyroiditis were retrospectively analyzed.According to the treatment methods,87 patients were divided into the operation group 39 cases and the medical treatment group(conservative group) 48 cases.Patients were followed up for 6 months after treatment.The clinical effect 1 week after the end of treatment was compared between the two groups.The thyroid functionat 6 months after the end of treatment was compared.Results The incidence rate of thyroid hyperfunction (hyperthyroidism) of the operation group was 33.33％,which was significantly higher than 8.33％ in conservative group,the difference was statistically significant (x2 =8.554,P =0.003).The effective rate of short-term treatment of operation group and the conservative group was 89.74％ and 93.75％,the difference was not significant (x2 =0.467,P =0.495).After 6 months of treatment,the normal rate of thyroid function between the two groups had no statistically significant difference(x2 =4.947,P =0.084).In the conservative group,3 cases were diagnosed as thyroid carcinoma complicated with hyperthyroidism.Conclusion For patients with refractory subacute thyroiditis or cannot exclude malignant tumors,operation can achieve good effect and less complications.

Subacute thyroiditis presenting as acute psychosis: a case report and literature review

We describe herein an unusual case of subacute thyroiditis presenting as acute psychosis. An 18-year-old male presented at the emergency department due to abnormal behavior, psychomotor agitation, sexual hyperactivity, and a paranoid mental state. Laboratory findings included an erythrocyte sedimentation rate of 36 mm/hr (normal range, 0 to 9), free T4 of 100.0 pmol/L (normal range, 11.5 to 22.7), and thyroid stimulating hormone of 0.018 mU/L (normal range, 0.35 to 5.5). A technetium-99m pertechnetate scan revealed homogeneously reduced activity in the thyroid gland. These results were compatible with subacute thyroiditis, and symptomatic conservative management was initiated. The patient's behavioral abnormalities and painful neck swelling gradually resolved and his thyroid function steadily recovered. Although a primary psychotic disorder should be strongly considered in the differential diagnosis, patients with an abrupt and unusual onset of psychotic symptoms should be screened for thyroid abnormalities. Furthermore, transient thyroiditis should be considered a possible underlying etiology, along with primary hyperthyroidism.

Case of Subacute Thyroiditis Presenting as the Cause of Fever of Unknown Origin / 대한내과학회지

Fever of unknown origin (FUO) is not infrequently a diagnostic dilemma for clinicians. Common infectious causes include endocarditis and abscesses in adults, and noninfectious causes include neoplasms and certain collagen vascular diseases. Endocrine causes of FUO are rare. The only endocrine disorder likely to present as FUO is subacute thyroiditis. Subacute thyroiditis usually occurs in middle-aged women as viral prodrome, neck tenderness, classic symptoms of thyrotoxicosis, and an elevated erythrocyte sedimentation rate. The patient may have abrupt onset of fever and chills with complaints of thyroid pain, or only low-grade fever with poorly characterized anterior neck pain. We present a case of FUO in a 48-year-old female who had had fever and neck pain for more than one month. Despite an extensive evaluation, the patient had persistent fever and no cause was found, with the exception of subacute thyroiditis. The fever resolved from the second day of treatment with low-dose steroid (prednisolone, 10 mg per day). This case illustrates that subacute thyroiditis should be considered in cases of FUO.

Clinical analysis of 45 cases with subacute thyroiditis / 中国基层医药

Objective To investigate the clinical manifestations,etiology,diagnosis and treatment of subacute thyroiditis(SAT).Methods Retrospectively analyzed 45 patients with subacute thyroiditis.Results In the cases 45with subacute thyroiditis,generallymore women who were 30～50 years old accounted for 88%.The clinical symptoms is typical,mainly headache(99%)and thyroid pain and obvious local tenderness(100%).45 patients were significandy higher erythrocyte sedimentation rate;d-2 cases of FT3,FT4 increased significantly,and the level of thyroid stimulating hormone is reduced.All patients of non-steroidal glucocorticoid treatment were effective.Conclusion The vast majority of subacute thyroiditis with typical clinical manifestations,the therapy of non-steroidal class and adrenal corticosteroid therapy is effective.

A case of an autonomously functioning thyroid nodule combined with subacute thyroiditis / 대한내과학회지

The most common cause of thyrotoxicosis is Graves' disease, followed by toxic adenoma, multiple nodular toxic goiter, and temporary thyroiditis. At initial presentation, however, it is often difficult to recognizinge subacute thyroiditis as a thyroid disease is often difficult. In many cases, subacute thyroiditis may be mistaken for certain upper respiratory infectious diseases, due to their similar clinical manifestations. Additionally, when subacute thyroiditis coexists with a thyroid nodule or is accompanied by severe thyrotoxicosis, it can be misdiagnosed as a thyroid tumor, toxic adenoma, or Graves' disease. Here we report the case of an autonomously functioning thyroid nodule combined with subacute thyroiditis, which was nearly misdiagnosed as toxic adenoma. This is the first reported case in Korea of a patient who had an autonomously functioning thyroid nodule combined with subacute thyroiditis, which was nearly misdiagnosed as toxic adenoma.

Observation of dendritic cell and HLA-DR antigen expression in autoimmune thyroid diseases and subacute thyroiditis / 中华内分泌代谢杂志

Objective To investigate the effects of dendritic cell (DC) and HLA-DR antigen expression in the generation and development of Graves′ disease (GD), Hashimoto′s thyroiditis (HT) and subacute thyroiditis (SAT). Methods A morphologic study was performed on the thyroid tissue of 53 GD with pronounced lymphocytic infiltration, 52 HT and 31 SAT to investigate the pathologic changes of DC and HLA-DR antigen positive cell in the parenchymal cells and intestitial tissue by histochemical, immunohistochemical and electron microscopic technique and statistic analysis. Results The observation on DC and HLA-DR positive infiltrating cell in GD, HT and SAT showed a similar increase with the degree of cellular infiltation. The highest peaks of DC and HLA-DR positive thyroid follicular epithelium were in HT O-type and granulomatous area of SAT. The highest peaks of HLA-DR positive immunoactive cells was in HT P-type and fibrous area of SAT. Conclusion DC and HLA-DR positive cells may play an important role in the antigen-presenting step as well as in their direct cytotoxicity. These processes are related to the pathogenesis of AITD (GD and HT) and SAT. The thyroid follicules may be destroyed in the autoimmune reaction, and initially the patient presents hyperthyroidism and finally hypothyroidism follows because of the fibnosis of the follicules.

Diagnostic value of modified 6 hour-~(131)I uptake test in regard to the etiology of hyperthyroidism / 中华内分泌代谢杂志

~(131)I uptake by thyroid were assayed in 64 patients with Graves′ disease (GD) and 69 patients with non-GD hyperthyroidism. GD group had higher rate of ~(131)I uptake than non-GD group at 2, 6 and 24 h, and there was no overlap between the two groups at these 3 time points.~(131)I uptake at 2 and 6 h could differentiate GD fromlow ~(131)I uptakehyperthyroidism.

Coexistence of Hashimoto′s thyroiditis and subacute thyroiditis: report of two cases / 中华内分泌代谢杂志

Two unusual cases of coexistence of Hashimoto′s thyroiditis and subacute thyroiditis were reported. The diagnosis was based on the comprehensive analysis of clinical symptoms, laboratory data and histological findings. If patients with confirmed evidence of subacute thyroiditis were accompanied with markedly and persistently elevated titers of thyroid autoantibodies, coexistence of both diseases should be suspected.