The contribution of ultrasonographic findings to the prognosis of subacute thyroiditis

ABSTRACT Objective Ultrasound assessment plays an important role in the diagnosis, and monitoring of subacute thyroiditis (SAT). However, the relationship between ultrasonographic findings and severity or prognosis of the disease is not known. The aim of the present study was to evaluate the relationship between bilateral and unilateral disease involvement and severity and prognosis of the disease. Subjects and methods The initial laboratory values, ultrasonographic findings and long-term outcomes of 247 SAT patients were evaluated retrospectively. Results In the ultrasonographic evaluation, bilateral involvement was detected in 154 patients, and unilateral involvement in 93 patients at the time of diagnosis. No significant difference was found between patients with bilateral or unilateral disease at the time of diagnosis in respect of the initial acute phase reactants. FT4 was significantly higher and TSH was significantly lower in the group with bilateral disease. Bilobar or unilobar disease on ultrasound at the time of diagnosis was not found to be a risk factor for permanent hypothyroidism or recurrence. The mean thyroid volume was determined to be 22.5 ± 10 cm3 at the beginning of treatment, and 11.2 ± 8 cm3 at the end of treatment. The initial thyroid volume and the thyroid volume at the end of treatment were significantly lower in patients who developed hypothyroidism. Conclusion There was no relationship between initial acute phase reactants and bilateral or unilateral involvement of the disease. FT4 levels were found to be associated with the extension of the disease. The risk of recurrence and permanent hypothyroidism are not associated with the initial ultrasonographic aspect. Arch Endocrinol Metab. 2020;64(3):306-11

Painless thyroiditis associated to thyroid carcinoma: role of initial ultrasonography evaluation

Even though it is a rare event, most associations of thyroid carcinoma with subacute thyroiditis described in the literature are related to its granulomatous form (Quervain’s thyroiditis). We present a patient with subacute lymphocytic thyroiditis (painless thyroiditis) and papillary thyroid cancer that was first suspected in an initial ultrasound evaluation. A 30-year old female patient who was referred to the emergency room due to hyperthyroidism symptoms was diagnosed with painless thyroiditis established by physical examination and laboratory findings. With the presence of a palpable painless thyroid nodule an ultrasound was prescribed and the images revealed a suspicious thyroid nodule, microcalcification focus in the heterogeneous thyroid parenquima and cervical lymphadenopathy. Fine needle aspiration biopsy was taken from this nodule; cytology was assessed for compatibility with papillary thyroid carcinoma. Postsurgical pathology evaluation showed a multicentric papillary carcinoma and lymphocytic infiltration. Subacute thyroiditis, regardless of type, may produce transitory ultrasound changes that obscure the coexistence of papillary carcinoma. Due to this, initial thyroid ultrasound evaluation should be delayed until clinical recovery. We recommended a thyroid ultrasound exam for initial evaluation of painless thyroiditis, particularly in patients with palpable thyroid nodule. Further cytological examination is recommended in cases presenting with suspect thyroid nodule and/or non-nodular hypoechoic (> 1 cm) or heterogeneous areas with microcalcification focus.

Tender neck in a diabetic patient

A 45-year- old Indian patient with a history of type 2 diabetes mellitus presented with history of pain in his left side of the neck associated with sore throat of one month duration. The diagnosis of sub acute granulmatous thyrooiditis [De Quervain's thyroditis] was made which was confirmed radio logically by depressed radioactive iodine uptake [RAIU] 0%% uptake. Patient showed marked clinical response and improvement within 24 hours on anti- inflammatory drug and corticosteriods

Subacute thyroiditis as seen initially in ENT department--a report of 30 cases / 华中科技大学学报（医学）（英德文版）

To assess the pharyngeal presentations and the diagnostic value of thyroid SPECT and thyroid fine needle aspiratory biopsy (FNAB) in subacute thyroiditis (SAT) as seen initially in ENT department, 30 patients, during the course of SAT, were examined for pharyngeal symptoms and tested for serum T3, T4 level. The thyroid SPECT imaging or thyroid FNAB were performed. Our results showed that, of the 30 patients, 21 had sore throat of various degrees, and 9 had abnormal sensation of throat. Six were diagnosed as having SAT by only SPECT, in the remaining 24, the final diagnoses was established by SPECT combined with FNAB. Two of them were finally diagnosed as having SAT by trial treatment with oral prednisone. It is concluded that sore throat and abnormal sensation of pharynx are the important presentations of SAT, and thyroid SPECT imaging and thyroid FNAB are valuable in diagnosing SAT.