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Thyroid Disease (Harrison's)

Terms in this set (15)

X-15. and. X-16. The answers are E and B. (Chap. 335) Subacute thyroiditis, also known as de Quervain's thyroiditis, granulomatous thyroiditis, or viral thyroiditis, is a multiphase ill- ness three times more frequent in women than men. Multiple viruses have been impli- cated, but none have been definitively identified as the trigger for subacute thyroiditis. The diagnosis can be overlooked in patients as the symptoms mimic pharyngitis, and it fre- quently has a similarly benign course. In this patient, Graves' disease is unlikely given her elevated TSH and negative antibody panel. Autoimmune hypothyroidism should be con- sidered; however, the tempo of her illness, the tenderness of the thyroid on examination, and her preceding viral illness make this diagnosis less likely. Ludwig's angina is a poten- tially life-threatening bacterial infection of the retropharyngeal and submandibular spaces, often caused by preceding dental infection. Cat-scratch fever is a usually benign illness that presents with lymphadenopathy, fever, and malaise. It is caused by Bartonella henselae and is frequently transmitted from cat scratches that penetrate the epidermis. It will not cause an elevated TSH. Subacute thyroiditis can present with hypothyroidism, thyrotoxicosis, or neither. In the first phase of the disease, thyroid inflammation leads to follicle destruction and release of thyroid hormone. Thyrotoxicosis ensues. In the second phase, the thyroid is depleted of hormone and hypothyroidism results. A recovery phase typically follows in which decreased inflammation allows the follicles to heal and regenerate hormone.
Large doses of aspirin (such as 600 mg by mouth every 4-6 h) or nonsteroidal anti-in- flammatory drugs are often sufficient for what is usually a self-limited illness. A glucocor- ticoid taper can be used if symptoms are severe. Thyroid function should be monitored closely; some patients may require low-dose thyroid hormone replacement.