[Atypical presentation of subacute thyroiditis]

A 41-year-old woman had been treated with an antibiotic for a sore throat and a tender neck. Later, moderate hyperthyroidism developed and was treated with antithyroid drugs. She presented herself for further work-up when neck pain and malaise persisted. On palpation, the thyroid was tender and firm, but not enlarged. Signs and symptoms indicated moderate hyperthyroidism.

Laboratory findings included suppressed TSH, elevated thyroid hormones, and both elevated erythrocyte sedimentation rate and CRP. On ultrasound, the thyroid was found to be of normal size but severely hypoechoic. A thyroid scan showed low uptake of technetium.

The findings supported the diagnosis of subacute thyroiditis. Prednisolone treatment provided relief of pain within 2 days. The patient later developed hypothyroidism suggestive of Hashimoto's thyroiditis and required thyroxin supplementation.