Subacute thyroiditis — SCE Endocrinology MCQ

Correct answer: C — An NSAID with symptom-directed beta blockade

The best answer is “An NSAID with symptom-directed beta blockade”. Subacute painful thyroiditis releases preformed hormone from inflamed follicles; treatment is anti-inflammatory and symptomatic, with glucocorticoids reserved for severe or refractory pain. “Carbimazole for 18 months” is less appropriate because thionamides inhibit new synthesis and do not stop release of stored hormone “Radioactive iodine ablation during the painful phase” is less appropriate because radioiodine has no acute role in a self-limiting destructive thyroiditis “Levothyroxine during the current thyrotoxic phase” is less appropriate because thyroid hormone would worsen current thyrotoxicosis and is considered only if a significant later hypothyroid phase occurs “Urgent thyroidectomy to prevent later hypothyroidism” is less appropriate because surgery is disproportionate for a typically resolving inflammatory process

Reference: NICE NG145: Thyroid disease — assessment and management. https://www.nice.org.uk/guidance/ng145/chapter/Recommendations