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A 40-year-old female complains of low-grade fevers and anterior neck pain for 6 days. She
denies tremor, weight loss, or visual changes. Examination shows a tender and slightly
enlarged thyroid gland. There is no bruit. The rest of the examination is unremarkable. TSH is
low. T4 and T3 are both elevated. A radionuclide scan shows low uptake. Anti-TPO antibodies
are negative. What would be the most appropriate therapy at this point?
A. Radioiodine ablation
B. Methimazole
C. Prednisone
D. Levothyroxine
E. Surgery
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is it prednisone for hashimoto. i was thinking of D.
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4 subacute: asa, prednisone, propanolol
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Painful thyroiditis- usually dequervains- low radio i uptake and raised t4 , low TSH- all favour this.
prednisolone to reduce inflammation, painkillers, symptomatic tratment with beta blockers
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The answer is C.
This patient's history is most consistent with the thyrotoxic phase of subacute thyroiditis. The
peak incidence occurs between ages 30 and 50. The etiology is usually viral. There is a
significant female predominance. The low uptake on a radionuclide scan in the setting of a
recent onset of a painful thyroid clearly points to subacute thyroiditis. Elevation in T4 and T3
points to the thyrotoxic phase rather than the hypothyroid phase. The patient would be
expected to improve over the course of months, and so permanent ablation with radioiodine or
surgery is inappropriate. Antithyroid medications such as methimazole and propylthiouracil
(PTU) have no role because the pathophysiology of thyroiditis relates to destruction of the
gland and hormonal release, not hyperactivity, as in the case of Graves' disease and
multinodular goiter. Levothyroxine may play a role in the hypothyroid phase, but not while the
patient is acutely thyrotoxic. Anti-inflammatory medications such as nonsteroidal
anti-inflammatory drugs (NSAIDs) and steroids are most appropriate. Beta blockers would be
appropriate if the patient were having more symptoms of thyrotoxicosis.
