Recurrent subacute thyroiditis case of an elderly patient

Sema Hepsen; Bekir Ucan; Pinar Akhanli; Muhammed Kizilgul; Erman Cakal

doi:10.1530/endoabs.70.EP478

Introduction: Subacute thyroiditis (SAT) is the inflammatory disease of thyroid gland, which commonly affects middle-aged females. SAT is rarely seen in extreme age groups. Herein, we reported an 82-year-old patient presenting recurrent SAT.

Case report: An 82-year-old female patient presented fever, neck pain, weakness, and dizziness. She had hypertension and peripheral vascular disease. She had a 2-week of symptom history and admitted to emergency service before being referred to our clinic. Her body temperature was 38.6 °C and the heart rate was 105beats/minute. The thyroid gland was painful in palpitation. Hyperthyroidism and elevated acute phase reactants were observed. Thyroid ultrasonography showed bilateral hypoechoic heterogeneous areas. The patient having diagnosed SAT was started to use 48-mg methylprednisolone. The dose tapering protocol was 48–32–24–16–8–4 per week respectively. The severity of symptoms was decreased after three days of the initiation of the treatment. After 6-week of the treatment, laboratory and ultrasonography findings were resolved. 2 weeks after the completion of SAT treatment, the neck pain relapsed. Laboratory tests and thyroid ultrasonography were compatible with SAT. 48-mg methylprednisolone was started again with the same tapering protocol. At the end of the second treatment, TSH was 5.82 mIU/l while thyroid autoantibodies were negative. We presently continue to follow up the patient in the second month of SAT resolution.

Conclusion: In the evaluation of large patient groups, SAT was reported in very small numbers in patients whose ages were over 80. Although, the most well-known reasons for the SAT recurrence are short treatment period and genetic background, decreased immune response may be a possible risk factor for elderly patients. The symptoms of SAT can be more exaggerated and the management can be more challenging in elderly patients. Therefore, clinicians should be more careful about the treatment and follow-up of elderly patients with SAT.

**Table 1** Laboratory parameters in SAT processes.
	1. SAT	After treatment	2. SAT	After treatment	Reference range
Sedimentation, mm/h	62	6	42	18	0–20
CRP, mg/l	107	1.8	103	2.7	0–8
WBC	9500	10.100	7500	9700	3.57–
TSH, mIU/l	0.12	0.32	1.11	5.82	0.38–5.33
fT4, ng/dl	1.79	0.94	0.93	0.94	0.58–1.6
fT3, ng/dl	4.67	3.1	4.1	4.22	2.66–4.37
anti-TPO, IU/ml	0.3	0.3	0.3	0.2	0–9
anti-TG, IU/ml	0.9	0.9	0.9	0.9	0–4
SAT subacute thyroiditis, CRP C-reactive protein, WBC white blood cell, TSH thyroid-stimulating hormone, fT4 free thyroxin, fT3 free triiodothyronin, anti-TPO anti-thyroid peroxidase, anti-TG anti-thyroglobulin.

Figure 1 Ultrasonographic appearance of SAT.

Endocrine Abstracts

EP478