(Disclaimer: This article is for scientific use only, and the relevant information in the following content has been processed to protect patient privacy)
Abstract: This 50-year-old middle-aged uncle developed sore throat 2 months ago and was diagnosed with acute pharyngitis at a local hospital and given anti-infection treatment for improvement. Since then the sore throat still recurred, and for half a month the body temperature was often elevated, so he came to our hospital and was considered to have subacute thyroiditis after completing relevant tests. He was given oral medication, and his symptoms gradually subsided and his condition was controlled and stabilized.
Basic information】Male, 50 years old
Disease Type】Subacute thyroiditis
Hospital】The Second Hospital of Guangzhou Medical University
Date of consultation】April 2022
Treatment plan】Oral medication (etoricoxib tablets + methylprednisolone tablets)
Treatment Period】Inpatient treatment for 6 days, outpatient review after 1 week
Treatment effect] The anterior neck pain was significantly relieved, and the body temperature gradually decreased to normal.
I. Initial interview
The patient is male, 50 years old. After detailed medical history, we learned that the patient had a sore throat 2 months ago and was considered to have acute pharyngitis at the local hospital. In the past half month, the sore throat appeared again, but this time in a lower position, and the fever often started in the afternoon, reaching 39℃ at the highest. During this visit to the respiratory department, it was found that the sore throat was in the wrong place as he said. On examination of the thyroid gland, he was found to have mild enlargement and a hard texture, with pressure pain on palpation. Blood sampling for thyroid function showed FT: 36.31 pmol/L, FT: 420.46 pmol/L, TSH: 2.15 uIU/ml, and negative thyroid-related antibodies. Routine blood test showed leukocytes 12.75×10^9/L, neutrophils 9.25×10^9/L, and hematocrit 41mm/h (elevated). Thyroid ultrasound suggested subacute thyroiditis changes. Combined with the patient’s symptoms, signs and various examinations, subacute thyroiditis was considered as the diagnosis.
II. Treatment history
After the diagnosis was clear, the patient was recommended to be hospitalized. After the diagnosis was understood, the patient’s compliance was significantly improved. After admission, the patient was given the opportunity to exclude other febrile possibilities, and the results showed negative for Mycobacterium tuberculosis interferon, negative for antinuclear antibodies, antibody double-stranded DNA, and rheumatoid factor, and no abnormalities were seen on chest CT. There was no evidence of other causes of fever. The fever was considered to be caused by subacute thyroiditis.
Initially, oral etoricoxib tablets were given as anti-inflammatory treatment. After 3 days of administration, the patient gave feedback that the neck pain was only slightly relieved and he still saw recurrent fever with a maximum temperature of 38℃. So the etoricoxib tablets were discontinued and replaced by oral anti-inflammatory methylprednisolone tablets. After 2 days, the patient’s anterior neck pain symptoms were significantly relieved and the peak body temperature gradually decreased.
III. Treatment effect
After switching the patient to glucocorticoid methylprednisolone tablets, the anterior neck pain was significantly relieved and the body temperature gradually decreased to normal. The patient was discharged after 6 days of hospitalization, and was advised to pay attention to review. One week after discharge, the patient’s routine blood count, blood sedimentation and thyroid function were rechecked, and the results showed that the patient’s white blood cell count and neutrophil count had returned to normal levels, and thyroid function had basically recovered.
IV. Notes
We are glad that after active treatment during hospitalization, the patient’s neck pain has been significantly relieved, subacute thyroiditis has been controlled, and the body temperature has been reduced to normal. However, we still need to advise the patient to avoid straining in life, not to stay up late, not to smoke, and not to drink. At the same time, it is important to drink enough water every day and to eat a light and nutritious diet. You can eat more vegetables, fruits and high quality protein, such as fish and lean meat. Self-monitoring of body temperature and heart rate, regular review of blood count and sedimentation, do not stop the medication on your own, adjust the glucocorticoid dosage according to the recovery of the disease, and gradually reduce the dosage. At the same time, review the nail function regularly and adjust the treatment plan according to the changes of nail function.
V. Personal insight
Due to the unfamiliarity with the location of the thyroid gland, many patients are unable to distinguish the difference between sore throat and thyroid pain. For example, in this article, the patient had a sore throat that repeatedly failed to improve and even developed a fever, and only when he sought medical help again did he learn that it was caused by subacute thyroiditis. In mild cases of subacute thyroiditis, the local pain and systemic symptoms can be relieved by taking oral NSAIDs. However, for patients with moderate to severe cases, glucocorticoids are required to provide significant pain relief. And after the symptoms improve, the dosage needs to be gradually reduced rather than suddenly stopped to avoid recurrence and worsening of the disease, and the sudden stopping of the drug may lead to fatigue and weakness and other hormone withdrawal reactions. These are the details that patients are most likely to overlook in the treatment process.