Case history
Case history
A 40-year-old woman with no prior thyroid history presents with 7 days of fevers to 104°F (40°C), shaking chills, myalgias, and pharyngitis. In the last day, she has developed severe neck pain that radiates to her ear and jaw. She notes rapid heartbeat, palpitations, tremors, and feeling hot. The neck pain is severe and has changed from the left side of her neck to the right side in the last 24 hours. She cannot eat or drink anything because it exacerbates the pain. She indicates that the pain is not in her pharynx but over her lower neck and radiates to her ear and jaw. She is mildly distressed and will not let you touch her neck because it hurts so much. On examination, her thyroid is enlarged, firm, and very tender to palpation.
Other presentations
Occasionally, the patient may present with little or no neck pain but with high serum ESR levels, a triphasic course of thyroid dysfunction, and a firm goiter. Only a minority of patients exhibit the clinical manifestations accompanying all 3 phases of subacute thyroiditis (thyrotoxicosis, hypothyroidism, and euthyroidism). Some patients have only the thyrotoxic phase, while others may present only in the hypothyroid phase. Other patients do not have neck pain, but may present with fever of unknown origin.[6]
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