Endocrine Abstracts

Introduction: Diagnosis of sub acute thyroiditis is readily considered in a patient presenting with classical history and characteristic clinical features. Confirmation of diagnosis is based on particular set of laboratory investigations and supported by characteristic imaging findingsof Tc-99 scan. However, prescence of sub acute thyroiditis with normal thyroid scintigraphy findings is exceedingly rare.

Case report: 51 years old postmenopausal female with history of recurrent sub acute thyroiditis 10 years back presented with pain in neck initially over right side then later over the left for one and half month and fever for three days, heat intolerance, sleep disturbances, restlessness. Physical examination revealed enlargement and marked tenderness over the thyroid initially more marked on left side and after few days over the right side. Thyroid profile showed TSH 0.023 ulU/ml, FT4 2.31 ng/dl, FT3 2.74 ng/dl and TSH 0.008 ulU/ml, FT4 2.64 ng/dl, and FT3 2.5 ng/dl on two separate occasions. ESR was 94 mm/hr. Tc-99 m pertechnetate scintigraphy showed bilateral normal homogenous uptake. Clinical diagnosis of sub acute thyroiditis was made. Prednisolone started in tapering dose. Improvement in symptoms with normalization of ESR of 08 mm/hour and FT4 of 1.04 ng/dl occurred after taking prednisolone for six weeks at follow up.

Conclusion: This case presenting with typical clinical features of sub acute thyroiditis and elevated ESR but lack characteristic imaging emphasizes upon diagnosis of sub acute thyroiditis on the basis of history, physical examination and laboratory data even if thyroid scintigraphy findings are not in favor of disease.

Keywords: sub acute thyroidis, recurrent, normal thyroid scintigraphy