Subacute Thyroiditis vs Suppurative Thyroiditis: A Diagnostic Challenge
https://doi.org/10.15605/jafes.041.S1
- Author:
Jia En Chew
1
;
Ju Vern Ew
1
;
Albert Li Ren Chong
1
;
Eunice Yi Chwen Lau
1
Author Information
1. Endocrinology Unit, Department of Medicine, Sibu Hospital
- Publication Type:Journal Article
- MeSH:
Thyroiditis, Subacute;
Thyroiditis, Suppurative
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):121-122
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Subacute thyroiditis (SAT) and acute suppurative
thyroiditis (AST) are two distinct inflammatory conditions
but share many overlapping clinical and biochemical
features, which may pose a diagnostic challenge. We report
a case of SAT mimicking AST.
Case:A 39-year-old female presented with a 3-week history of
painful neck swelling and symptoms of thyrotoxicosis,
including palpitations, heat intolerance, and diaphoresis. She
had no family history of thyroid disease. On examination,
she was febrile and had a smooth and tender goiter. Her
blood tests showed leukocytosis with elevated erythrocyte
sedimentation rate and C-reactive protein. Her thyroid
function test (TFT) showed thyroid-stimulating hormone of
0.023 mIU/L and free thyroxine 4 of 32.15 pmol/L.
An urgent ultrasound revealed a large, ill-defined
heterogeneously hypoechoic lesion predominantly at
the left lobe of the thyroid gland with mild intralesional
vascularity. These were reported as features of thyroiditis
with infective or early suppurative changes. Fine needle
aspiration (FNA) of the lesion was attempted by the
radiologist but was unsuccessful.
She was treated with intravenous antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs), but symptoms
persisted. Repeated ultrasound and computed tomography
scans about 1 week later confirmed an enlarged thyroid
gland with no obvious lesion or collection within the gland.
The diagnosis was revised to SAT, and prednisolone 15 mg
OD was started. This resulted in rapid improvement in her
symptoms and inflammatory markers.
Four weeks later, she remained asymptomatic, and
prednisolone was gradually tapered off. Serial TFT
monitoring showed a classic triphasic pattern with an initial
hyperthyroid phase, followed by hypothyroidism before
returning to euthyroidism.
Conclusion:SAT can present with a focal lesion on the ultrasound
during the early stage of the disease, making it difficult
to distinguish from a thyroid abscess due to overlapping
features. Good clinical judgement guided by FNA
and appropriate follow-up imaging may be helpful in
differentiating between the two conditions.
- Full text:202608051002523503EP_A182.pdf
