Endocrine Abstracts

Subacute thyroiditis (SAT) is a self-limited inflammatory disease of presumed viral etiology, characterized by pain and thriphasic functional thyroid evolution. We report the case of an 54-years-old woman hospitalized in 02.2008 at the Gastroenterology Department for fever, diahreea, significant weight loss (5 kg in one month), with the suspicion of Crohn’s disease (CD). Two weeks before she presented a subfebrile episode with bilateral jugular lymphadenopathy, dysphagia, myalgia, treated with antibiotics. High ESR and CRP values confirmed the inflammatory syndrome, but normal irigography and colonoscopy infirmed the suspicion of CD. The adenopathy suggested infectious mononucleosis (IMN) sustained by positive Epstein-Barr antibodies (IgG=18.1), and high hepatic enzymes. During the hospitalization she presented tachycardia, tremor, thyroid enlargement, and was transferred in the Endocrinological Department. High fT4 (3.6 ng/dl) with inhibited TSH (0.1 mUI/l) confirmed thyrotoxicosis. Thyroid ultrasound (US) revealed inhomogenous hypoechoic pattern with the presence of a 18/16 mm nodule with imprecise limits, and internal Doppler signal. She had moderate sensitivity at thyroid palpation but when FNAB was performed she presented intensive pain. Cytology was suspicious. CT normal 2.2 pg/ml. The persistence of the inflamatory syndrome (ESR 90 mm/h) with the suspicion of IMN determined corticotherapy followed by a spectacular improvement: disparition of fever, diminution of ESR (51 mm/h), amelioration of the US (inhomogenous, hypoechoic zone on the nodule topography, no vascularization). Corticotherapy continued and 2 months later, after a short period of hypothyroidism, thyroid function, ESR (5 mm/h) and hepatic enzymes were normalized, lymph nodes were no more palpable and she had no phisical complaints.

SAT may mimic various thyroid and systemic diseases. Particulary for our case were the mild pain, domination of digestive symptoms and the presence of the adenopathy, which first suggested CD or IMN. The association of signs suggesting thyrotoxicosis impose, in such cases, the investigation of the thryoid function.