Endocrine Abstracts

Introduction: Acute thyroiditis is rare disease and it affects mainly immunocompromised patients. First line antibiotics for treatment are Ampicillin and Cephalosporin.

Case report: 30 y/o woman presented with neck pain and according clinical-laboratory tests was diagnosed with subacute thyroiditis.

• TSH-0.018(0.350–4.940 µIU/ml);

• FT4–32, 32 (9, 01–19, 05 pmol/l)

• CRP-151.25 (<5 mg/l)

• WBC-10.81( 3.50–10.00) 10⁹/l

• E.S.R 48(<20 mm/h)

• Thyroid ultrasonography- Left lobe –10.7 cm³, right lobe 10, 9 cm³. With autoimmune thyroid disease signs.

Treatment with methylprednisolone 16 mg was started and after releasing of pain, gradually lowered. After withdrawal of hormone in about 8 weeks, patient’s pain returned. NSAID was initiated, but treatment did not help and patient began to take again methylprednisolone. After second withdrawal of hormone in 6 weeks, more acute pain came back, with swollen left side of neck, dysphagia and dysphonia. Patient decided to take 4 mg methylprednisolone for 2 days, which did not help and she came for evaluation. Thyroid ultrasonography – Left lobe enlarged –14.6 cm³, right lobe reduced-6.7 cm³. In left lobe was infiltrate-like appearance lesion.

• TSH-0, 39 (0.27–4.2 µIU/Ml)

• WBC- 11.87 (4.4–11.3 10^3/mm^3)

• Neutrophils% 85.3%( 50–75)

• ESR 3 mm/hr < 25ESR.

Patient refused to take additional tests- CT and FNA, due to financial reasons. Treatment for acute thyroiditis with Amoxicillin/clavulanic acid 2000 mg daily was started and methylprednisolone stopped. Patient had-allergic rash and itching on face. She remembered, that she had previously allergy on cephalosporin. Because of that Amoxicillin was replaced with Levofloxacin 500 mg and after 1 week patient presented without symptoms.

• WBC-8.63 10^3/mm^(3 4.4–11.3)

• Neutrophils% 67.6%( 50–75)

• ESR 7 mm/hr < 25ESR

• Thyroid ultrasonography-left lobe was reduced in size twice.

We continued treatment for 1 more week and patient was fully recovered. After 2 months she reports to feel great.

Conclusions: Notwithstanding, that we had limited diagnostic resources and we did not know real pathogen, after good result on antibacterial therapy we can confirm, it was acute thyroiditis. Was it due to glucocorticoids, was it acute thyroiditis from beginning, or some other anatomic reason – we could not find out. It is unusual case, because of patient’s young age and overall health. Also it is interesting, because Fluoroquinolone is not widely used in acute thyroiditis and we can suggest it as an effective treatment option.