Subacute thyroiditis — SCE Endocrinology MCQ

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ModerateThyroidSubacute thyroiditisSCE Endocrinology

A 41-year-old woman develops anterior neck pain after a viral illness. ESR is 78 mm/hour, TSH is <0.01 mU/L, free T4 is 34 pmol/L and radioiodine uptake is low. She has no eye signs and TSH receptor antibodies are negative. What is the most likely diagnosis?

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Correct answer: D — Subacute de Quervain thyroiditis

Subacute de Quervain thyroiditis is best because painful thyroiditis with raised inflammatory markers, transient thyrotoxicosis and low uptake is typical of subacute thyroiditis. The alternatives are less appropriate because Graves' has antibody positivity and increased uptake; nodular autonomy has focal or patchy uptake; carcinoma is usually not acutely thyrotoxic; TSHoma has non-suppressed TSH. The SCE teaching point is to integrate the clinical pattern, biochemistry and context rather than treating an isolated result.

Reference: NICE NG145