new_n_lost
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A 45-year-old woman presents to her physician because of a severe "sore throat." Physical examination demonstrates fever and an extremely tender, enlarged thyroid gland, but no throat erythema. Serum thyroid studies demonstrate a mild degree of hyperthyroidism. Two months later, the patient is asymptomatic, and thyroid function tests have returned to normal. She never again experiences difficulty with her thyroid function.
Which of the following was the most likely cause of her hyperthyroidism?
A. Diffuse nontoxic goiter
B. Graves’s disease
C. Hashimoto's thyroiditis
D. Subacute granulomatous thyroiditis
E. Subacute lymphocytic thyroiditis
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| rock
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E
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| mytime
Kick my butt!
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D coz probably a viral..E in pregnency.
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| mytime
Kick my butt!
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 pregnancy, sorry typo
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| rock
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thats right...should be D...E will be in pregnancy. i did not pay attention and jumped on to E as the answer. learnt a tip for solving questions today.
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| epica
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, D
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| me007
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why pregnancy?
i thought it is follows viral - coxakie infection
mcc of painful thyroiditis.
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| new_n_lost
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Yup the Answer is D
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| new_n_lost
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The correct answer is D.
This patient most likely has subacute granulomatous (de Quervain's) thyroiditis, which frequently develops after a viral infection. Microscopically, it is characterized by microabscess formation within the thyroid, eventually progressing to granulomatous inflammation with multinucleated giant cells. Clinically, patients may experience fever, sudden painful enlargement of the thyroid, and/or symptoms of transient hyperthyroidism. The disease usually abates within 6 to 8 weeks.
Diffuse nontoxic goiter (choice A) by definition does not produce hyperthyroidism.
The hyperthyroidism of Graves disease (choice B) does not spontaneously remit.
Hashimoto's thyroiditis (choice C) can cause transient hyperthyroidism, but then goes on to cause hypothyroidism.
Subacute lymphocytic thyroiditis (choice E) can cause transient hyperthyroidism, but is characteristically painless
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| new_n_lost
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The 3 types of subacute thyroiditis are:-
- Subacute granulomatous, also referred to as painful thyroiditis
- Subacute painless thyroiditis, which is silent and also referred to as lymphocytic thyroiditis
- Postpartum thyroiditis.
The etiology of each of these conditions is different, but all of the conditions follow the same clinical course, including 6-8 weeks of thyrotoxicosis, 2-4 months of mild hypothyroidism, and, finally, a return to the euthyroid state in 90-95% or more of the patients. A patient may experience 1 or more of these phases.
Patient presentation depends on the etiology of the thyrotoxicosis.
Subacute granulomatous thyroiditis is associated with an acute viral like illness with fevers and myalgias with a painful thyroid.
A recent birth signals postpartum thyroiditis.
Often, the thyrotoxicosis of silent thyroiditis, postpartum thyroiditis, or surreptitious use of thyroid hormone is symptomatic because of persistent tachycardia, nervousness, and weight loss.
Symptoms of thyrotoxicosis that persist for longer than 2 months are probably not caused by subacute thyroiditis.
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| new_n_lost
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Subacute painful, granulomatous, or de Quervain thyroiditis: These patients have the classic presentation of a viral illness. The onset is sudden, with high fever, myalgia, and neck pain.Patients often present with an acute virallike illness characterized by high spiking fever, malaise, myalgia, fatigue, and prostration. Neck pain from the thyroiditis can be extremely painful, preventing swallowing of saliva, liquids, and food. The pain starts in the lower neck and can radiate to the jaw or ear on that side. Thyroid hormone levels are often extremely elevated, resulting in marked signs and symptoms of thyrotoxicosis. Cases of lesser severity also exist, and the etiology may be confusing.
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| new_n_lost
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Subacute silent thyroiditis or lymphocytic thyroiditis: This form is associated with a painless, firm enlargement of the thyroid gland and high thyroid hormone levels. Only suspicion by the clinician and use of radioactive iodine uptake measurement can distinguish Graves hyperthyroidism from silent thyroiditis. Patients present with a nonpainful thyroid enlargement and elevated thyroid hormone levels. This condition must be distinguished from Graves thyrotoxicosis because antithyroid medication is not indicated in this temporary condition. Certain drug exposures relating to excess iodine and cytokines may cause this form of silent thyroiditis. These drugs include amiodarone (iodine-rich), interleukin-alpha, interleukin 2, and lithium. Silent thyroiditis resulting from these different medications is typically treated similarly
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| new_n_lost
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Subacute postpartum thyroiditis: This form is associated with a painless, firm enlargement of the thyroid gland and high thyroid hormone levels. The identifying feature is its occurrence 1-6 months after childbirth. Autoimmune hyperthyroidism from Graves disease can also occur for the first time postpartum and must be distinguished from postpartum thyroiditis. Both conditions are associated with high antithyroid antibody titers. This condition is likely autoimmune in nature. Patients develop an autoimmune goiter and permanent hypothyroidism more often than with the painful form of subacute thyroiditis. Patients with positive test results for thyroid autoantibodies either before their pregnancy or during the third trimester are at much higher risk of developing postpartum thyroiditis. Cigarette smoking is also associated with an increased incidence of postpartum thyroiditis. Once patients have an episode of subacute postpartum thyroiditis, they are likely to have additional episodes following each pregnancy.
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| keepgoing
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wow gr8 review of the topic...thanks nnl
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