Endocrine Abstracts

Introduction: Subacute thyroiditis (ST) is a self limited condition; relapse is rarely seen. Anterior cervical complains and inflammatory syndrome is highly suggestive.

Aim: We report a series of female cases associating arelapse of ST which was confirmed after the admission for atypical distant symptoms as diffuse headache or ear pain.

Material and Methods: The endocrine profile is presented.

Results: A 48-year patient was diagnosed with ST one year ago and treated with daily prednisone for 3 months. On admission, she complains of asthenia, palpitations, but mostly of persistent headache (not correlated with arterial hypertension). Thyroid exam revealed a mild pain. Inflammatory tests showed: erythrocyte sedimentation rate (ESR) of 63 mm/1-h, fibrinogen of 659.932 mg/dl (N:200–500), C reactive protein (CRP) of 3.5 mg/dl (N:0-1 mg/dl). Thyroid ultrasound showed: intense inhomogeneous aspects, a few nodules of <1 cm. TSH was suppressed (of 0.016 μUI/ml, N:0.5–4.5 μUI/ml), high freeT4 (of 47.4 pmol/l, N:10.3–24.4 pmol/l), and negative autoimmunity: TPO (anti-thyreoperoxidase antibodies) of 10 UI/ml (N:0–35 UI/ml), TRAB (TSH-Receptor antibodies) of 0.3 UI/ml (N:<1UI/ml). ¹³¹I radioiodine uptake was low: of 2% (at 2-h; N:12±5%), respective of 3% (at 24-h, N:35±5%). Oral cortico-therapy (daily prednisone up to 20 mg/day) was further recommended for 8 more weeks (when ESR decreased to 4mm/1-h, and TSH normalized to 2.27 μUI/ml).

A 37-year subject has an episode of ST 6 months ago and she was treated with non-steroidal anti-inflammatory drugs. She was admitted for persistent intense bilateral ear pain, weight loss (5 kilos/last month), and mild anterior cervical sensibility only at palpation. Intense inhomogeneous pattern at ultrasound was correlated with inhibited ¹³¹I radioiodine uptake: of 0.8% (2-h), respective of 0.2% (24-h). ESR of 109.6 mm/1-h, and CRP of 25 mg/dl, TSH<0.03 μUI/ml were consistent for relapse of ST. After 2 months of prednisone ESR became 5.9 mm/1-h, and TSH=1.7 μUI/ml.

Conclusion: Headache or otalgia represents atypical symptoms as clue for a relapse ST.