Subacute Thyroiditis in the Western Region of Saudi Arabia

The aim of this study is to assess the clinical presentation of 23 patients with subacute thyroiditis and the diagnostic value of radionuclear scan at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. This is a cohort study which consists of all the patients who visited the Endocrinology clinic with a suspected diagnosis of subacute thyroiditis between July 2002 and July 2004. Medical charts including data of the age, sex, clinical presentation, systemic symptoms and clinical examination of the thyroid gland were reviewed. The laboratory data included WBC count and its differential count, ESR, thyroid function test and thyroid antibodies. The radionuclear scan results were also noted. The mode of therapy provided to patients and the outcome of the treatment during a follow up period of two years was reported. A t otal of 23 adult patients with subacute thyroiditis (15 females and 8 males with a female to male ratio 1.9:1) were reviewed over a two year period. The mean age was 35.8±9.2 years. Eighteen patients (78%) had an upper respiratory tract infection at the initial clinical presentation. Twenty patients (87%) visited an ENT specialist for a sore throat and an abnormal sensation in the throat at least two weeks before presentation to the endocrinologist. Two patients were admitted to a medical unit with a diagnosis of fever of unknown origin for four weeks. All patients had an elevated FT4 (35.7±19.8 pmol/L) and a suppressed TSH (0.043±0.065 IU). Radionuclear san showed either no uptake at all in 12 patients or minimal uptake in 11 patients (0.32±0.55%). Eight patients (35%) received predinsolone therapy alone with an average dose of 30-40 mg daily for 7-8 days; 7 patients (30%) were treated with nonsteroidal anti-inflammatory drugs only. Eight (35%) patients were treated with both NSAIDs and corticosteroids. Hypothyroidism, with elevated TSH, was observed in 6 (26%) of our patients with positive thyroid antibodies during the first 6 months of follow up. There were no reported cases of recurrent or permanent hypothyroidism in our cohort study. Subacute thyroiditis is an uncommon disease that should be considered in the differential diagnosis of acute anterior neck pain, sore throat and fever especially if patients do not respond to treatment. In the clinical setting, radioiodine uptake can help exclude other diseases, confirm the diagnosis and expedite the initiation of appropriate therapy to relieve symptoms.