Test Your Knowledge: A woman with fever and neck pain

1. The presence of fever and thyroid pain and tenderness, biochemical hyperthyroidism, and high ESR together make the diagnosis of subacute thyroiditis most likely.1,2 Subacute thyroiditis is also known as de Quervain’s thyroiditis and granulomatous thyroiditis. It is believed to be caused by viral infection. In this condition, despite the marked release of thyroid hormones from the damaged thyroid follicular cells, clinical hyperthyroidism occurs only in 50% of patients, and the thyrotoxic symptoms are not serious and are transient. Because of this, it can be missed clinically. Furthermore, her thyroid pain was quite mild. In some case, the thyroid pain can be absent, and fever is the only manifestation.3 In acute suppurative thyroiditis, ESR is also elevated but the thyroid function is normal. Postpartum thyroiditis and Hashimoto’s thyroiditis may have a brief period of thyrotoxicosis but they do not have thyroid pain, and ESR is normal.