Gyrus Daily Questions; Internal Medicine #7

[cingulate.gyrus]

Which of the following is consistent with a diagnosis of subacute thyroiditis?


A. A 38-year-old female with a 2-week history of a painful thyroid, elevated T4, elevated T3, low TSH, and an elevated radioactive iodine uptake scan


B. A 42-year-old male with a history of a painful thyroid 4 months ago, fatigue, malaise, low free T4, low T3, and elevated TSH.

C. A 31-year-old female with a painless enlarged thyroid, low TSH, elevated T4, elevated free T4, and an elevated radioiodine uptake scan

D. A 50-year-old male with a painful thyroid, slightly elevated T4, normal TSH, and an ultrasound showing a mass

E. A 46-year-old female with 3 weeks of fatigue, low T4, low T3, and low TSH

[heartbeat]

Most probably correct answer is (B)=late course of the disease
*Initial state of disease is associated with painful gland, high T3 and T4 with low TSH and no increase in RAI uptake so answer (A) and (C) are wrong
*late state of disease associated with low level of T4 and T3 with increase in TSH so answer (E)
*Subacute thyroiditis is not associated with mass so answer (D) is wrong

[numbndumb]

the answer must be B. I agree with heartbeat

[cingulate.gyrus]

The answer is B.

Subacute thyroiditis, also known as de Quervain’s thyroiditis, granulomatous thyroiditis, and viral thyroiditis, is characterized clinically by fever, constitutional symptoms, and a painful enlarged thyroid.

The etiology is thought to be a viral infection. The peak incidence is between 30 and 50 years of age, and women are affected more frequently than are men. The symptoms depend on the phase of the illness.

During the initial phase of follicular destruction, there is a release of thyroglobulin and thyroid hormones. As a result, there is increased circulating T4 and T3, with concomitant suppression of TSH. Symptoms of thyrotoxicosis predominate at this point. Radioiodine uptake is low or undetectable.

After several weeks, thyroid hormone is depleted and a phase of hypothyroidism ensues, with low unbound T4 levels and moderate elevations of TSH. Radioiodine uptake returns to normal.

Finally, after 4 to 6 months, thyroid hormone and TSH levels return to normal as the disease subsides.


Patient A is consistent with the thyrotoxic phase of subacute thyroiditis except for the increased radioiodine uptake scan.

Patient C is more consistent with Graves’ disease with suppression of TSH, an elevated uptake scan, and elevated thyroid hormones as a result of stimulating immunoglobulin.

Patient D is consistent with a neoplasm.

Patient E is consistent with central hypothyroidism

[XpaezX]

MMMM we all know its probably viral in nature..

We also know that due inflammation it can give at the beginning some symptoms of Hyperthyroidism.. however the RAI scan IS decreased not increased.. it is the inflammation and destruction of they thyroid cells which is producing the symptoms..

SO in reality youll have: HIGH T4/T3, LOW TSH and LOW RAI uptake along with a PAINFUL thyroid gland.

The only one that covers up most the criteria is Option B, eventho they didnt put the RAI scan.