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Abstract: Xiao Wu is a young teacher with a graduating class who often stays up late to correct homework. One week after he got well from a cold, he suddenly felt pain in the front of his neck and ears, sometimes coldness, mild low fever, and significant thyroid tenderness. The test results indicated a slight elevation of thyroxine and elevated blood sedimentation, and he was diagnosed with subacute thyroiditis. After being given medication, her anterior neck and ear pain gradually subsided and her condition gradually recovered.
Basic information】Female, 29 years old
Type of disease】Subacute thyroiditis
Hospital】The Second Hospital of Guangzhou Medical University
Date of Consultation】April 2022
Treatment plan】Oral medication (Celecoxib capsule)
Treatment Period】1 week of outpatient treatment, regular review every month
Effectiveness】Significant relief of anterior neck pain and disappearance of postauricular pain
I. Initial consultation
A young patient, Xiao Wu, who used to be a people’s teacher, took the graduation class this year and often stayed up late to correct homework, caught a cold half a month ago. He was found to have a mildly enlarged, hard thyroid gland with significant tenderness by palpation. The thyroid function was checked and showed FT3: 4.7 pmol/L, FT4: 24.77 pmol/L (mildly elevated), TSH: 0.907 uIU/ml, negative thyroid-related antibodies, and a blood sedimentation of 37 mm/h (elevated). Thyroid ultrasound suggested subacute thyroiditis changes. Combining the patient’s symptoms, signs and various tests, subacute thyroiditis was considered as the diagnosis.
II. Treatment history
We explain the test results and diagnostic considerations to the patient and tell him that subacute thyroiditis is usually associated with viral infections, such as influenza virus and coxsackievirus, and is usually triggered after a cold or pharyngitis. Due to the destruction of the thyroid follicles and the inflammation, there is varying degrees of pain in the location of the thyroid gland, even radiating to the ears and head, and even a rise in body temperature.
The patient’s thyroid function suggested mild elevation of thyroxine and blood count was elevated although the white blood cells were normal. The patient was then given oral celecoxib capsules and instructed to drink more water to help metabolize the inflammatory factors and improve the fever symptoms, and was advised to pay attention to the combination of work and rest and avoid staying up late and straining.
III. Treatment effect
When I saw the patient again 1 week later, the patient said that the anterior neck pain had improved a lot, the ear pain had disappeared, and no discomfort had occurred during the medication period. The patient’s thyroid gland was then palpated and was only slightly painful to the touch when pressed hard, and his condition basically recovered. The patient was instructed to review his thyroid function and blood sedimentation every month at the outpatient clinic.
IV. Notes
We are glad that the patient recovered from his condition. Although he can return to work, we suggest that he should not work too hard, especially not to stay up late to correct homework, so as not to aggravate his already improved condition. Recently, it is advisable to have a light diet and eat more vitamin and mineral-rich vegetables and fruits. Ensure the daily energy supply and enhance physical fitness. Strenuous exercise should be avoided to speed up the metabolism and increase the burden on the heart and body. You can choose walking, cycling and other forms of exercise. Come to the outpatient clinic every month for rechecking thyroid function and blood sedimentation to keep abreast of the changes of thyroid hormones.
V. Personal insight
Subacute thyroiditis occurs mostly in young and middle-aged women, as in the case of the young teacher in this article. If there is a recent history of upper respiratory tract infection, neck pain, possibly accompanied by fear of heat, excessive sweating, panic, or even muscle pain and fever, you should be screened for this disease. This patient belongs to the mild type of subthyroiditis. The disease can even cause thyrotoxicosis, resulting in a significant elevation of thyroid hormones, and later on, hypothyroidism may also manifest because the inflammation makes the stored thyroid hormones to be released. As a physician, it is important to maintain follow-up visits with patients to help them have regular follow-ups and adjust their treatment plans in a timely manner.