Subacute granulomatous thyroiditis (SAT), first described by De Quervain in 1904, also known as De Quervian thyroiditis, or granulomatous thyroiditis, is a common clinical thyroid disorder with an incidence of 1-5%. The pathogenesis of subacute thyroiditis is not fully understood and is most commonly seen in HLA-B35-positive women or HLA-B67-positive patients. The currently accepted pathogenesis is related to viral infection, destruction of thyroid follicular cells, and release of colloids that cause an autoimmune response, with elevated CD4+/CD8+ ratios on T-lymphocyte subsets. Clinical manifestations Patients have an acute onset, often with signs and symptoms of upper respiratory tract infection such as fever, with chills, fatigue and loss of appetite, and enlarged lymph nodes. The most characteristic manifestation is pain and pressure in the thyroid gland, often radiating to the submandibular area, behind the ear, or in the neck, and worsening when chewing and swallowing. The gland is enlarged, hard, and painful to the touch. When the lesion is widespread, the follicular thyroid hormone is released into the blood in large amounts on a transient basis, which may still cause the common manifestations of hyperthyroidism, such as transient palpitations, sweating, and impatience, but usually for no more than 2 to 4 weeks. Patients feel very annoyed and distressed, which hinders their daily work and life. Treatment The current clinical treatment of this disease is still based on hormones and non-steroidal anti-inflammatory and analgesic drugs. The application of non-steroidal anti-inflammatory drugs alone is not etiological treatment though, because it has the ability to inhibit cyclooxygenase activity, block the inflammatory effect of prostaglandins, and inhibit the aggregation, activation and chemotaxis of inflammatory cells, thus inhibiting the release of inflammatory mediators and reducing tissue damage. However, non-steroidal anti-inflammatory and analgesic drugs alone are slow to relieve symptoms, especially goiter and thyroid nodules. Hormones are immunosuppressive and are most effective in autoimmune induced subacute thyroiditis. Although hormone therapy alone can provide rapid symptom relief, most of them are not long lasting and are prone to relapse after discontinuation of the drug and have many adverse drug reactions. Therefore, I explored the combination of Chinese and Western medicine in the treatment of subacute thyroiditis. In order to improve the clinical efficacy and reduce the adverse drug reactions. The treatment of subacute thyroiditis is mostly classified as carbuncle or tumor, and the treatment is mostly based on clearing heat from the liver and activating blood circulation to remove blood stasis. Therefore, I have achieved good results in treating subacute thyroiditis with Xiaojin Pill combined with Nimesulide (please refer to “China General Clinical November 2009, Vol. 25, No. 11, pp. 1166-1168). Prognosis Because many medical textbooks describe the disease as self-limiting, meaning that most patients experience complete remission over a period of weeks to months, some clinicians may forgo drug therapy. From the cases observed clinically, patients who give up medication are often very distressed, with prolonged illness for months, with mild and severe symptoms, and in a few cases even for 1-2 years, with individual patients suffering from permanent hypothyroid sequelae due to repeated inflammation destroying the thyroid gland.