When you think of thyroid disease, you may think of hyperthyroidism, hypothyroidism, thyroid nodules and a host of other names, but you may not know that subacute thyroiditis (hereinafter referred to as “subthyroiditis”) is also a common and easily overlooked thyroid disease. Many patients with subacute thyroiditis are often diagnosed after many visits, which is a painful experience! A. Neck pain, fever, it is the fault of subluxation Ms. Wang repeatedly had pain in the throat for the past 3 weeks, accompanied by fever, and had been seen in internal medicine and otorhinolaryngology, and had been treated with antiviral and anti-infective treatment according to “acute pharyngitis” and “acute tonsillitis”, but Her temperature dropped and rose again, so it was obvious that the previous treatment was not effective, so she could not devote herself to the work at hand. On the same day, Ms. Wang complained of neck pain, and I noticed that her bilateral thyroid glands were Ⅱ° enlarged, with obvious tenderness and heart rate of 110 beats/min. Considering that Ms. Wang had a history of cold 3 weeks ago, and that her thyroid gland had obvious pressure pain, coupled with palpitations and fever, she was highly considered to have “subthyroiditis”. The next step was to improve C-reactive protein and blood sedimentation, which indicated abnormally high levels, and thyroid hormones, which indicated significantly higher FT3 and FT4, significantly lower TSH, and significantly lower iodine uptake in the thyroid gland, all of which supported the diagnosis of “subthyroiditis”. She was treated with oral prednisone and propranolol, and her neck pain, fever and palpitations gradually disappeared. The thyroid gland is one of the most important endocrine organs in the human body. It is located below the laryngeal node and below the middle of the neck and is “H” shaped, like a beautiful bow wrapped around both sides of the trachea. The thyroid gland weighs only 20-30g, which may seem “insignificant”, but it is actually “very important”! Thyroid hormones are involved in our basal heart rate and body temperature, as well as the speed of gastrointestinal motility. It is no exaggeration to say that the thyroid gland influences the metabolism of many systems and cells in our body. The thyroid gland is composed of numerous follicles of varying sizes, and the follicular epithelium is the site of thyroid hormone synthesis and secretion. In other words, each follicular epithelial cell is a small warehouse for thyroid hormone storage. The typical subthyroiditis is generally divided into the thyrotoxic phase, the hypothyroid phase and the recovery phase. In the early stages of the disease, when the viral infection invades the thyroid follicles, the arrow is on the string and a war without smoke and mirrors is fought. Although there is no alarming gunfire, there is an “undercurrent” between the organism and the virus, and the virus opens the door of many stores like a key. symptoms. At the same time, the thyroid gland itself is exhausted by the frequent viral attacks, and at one point, the iodine uptake rate is reduced, resulting in a “separation” between thyroid hormone levels and iodine uptake by the thyroid gland. This is an important feature that distinguishes subthyroiditis from other thyroid disorders. As the disease evolves, the local war in the thyroid gland causes depletion of the thyroid hormones stored in the follicles, and the thyroid gland is full of sores, with various repair projects and reconstruction tasks to be carried out. This phase is often characterized by chills, fatigue, drowsiness and other symptoms. Immediately after the thyroid follicular cells are completely repaired, the patient enters a recovery phase, where blood sedimentation, C-reactive protein, thyroid hormone levels and iodine uptake are normalized, and the patient’s symptoms disappear. Treatment of subthyroiditis: relief of symptoms and elimination of causes Since subthyroiditis itself is a viral infection induced metaplastic thyroiditis, it is a devastating blow to the thyroid follicles during which it usually causes neck pain, which becomes a common symptom in patients with subthyroiditis. Therefore, symptomatic treatment needs to be given to improve the pain symptoms, and non-steroidal anti-inflammatory drugs can be preferred, but the current treatment measures taken treat the symptoms but not the root cause. We are well aware that in this war without smoke and mirrors, the thyroid gland can be roughly divided into 3 zones. Part of the zone has been in constant battle, part of the zone has been unscathed, and part of the zone has been damaged and undergoing reconstruction. “Glucocorticoids are used to suppress immune inflammation and stabilize the glandular cell membrane structure. When NSAIDs cannot effectively control pain, fever and other symptoms, glucocorticoids such as prednisone or hydrocortisone need to be applied to control the whole situation. It is worth mentioning that in the hyperthyroid phase, once the patient has palpitations, hand tremors and other manifestations of thyrotoxicosis, oral beta-blockers such as propranolol can be administered to regulate the heart rate, and antithyroid drugs should not be applied in this phase. If the thyroid follicles are destroyed excessively and not fully repaired at a later stage, very few patients with subthyroiditis will develop permanent hypothyroidism, requiring long-term oral levothyroxine tablet replacement therapy. From this perspective, early application of glucocorticoids can effectively inhibit metabolic reactions, reduce the extent of thyroid damage, and accelerate the progress of follicular repair, which can prevent and treat permanent hypothyroidism. Early identification of the disease is crucial, and standardized treatment can reduce the recurrence rate. We would like to remind you to pay attention to strengthening exercise and constantly improve your immunity to effectively avoid respiratory infections and thus prevent the occurrence of subluxation.