Follow-up of a case of subacute thyroiditis with uncommon thyroid 99mTc uptake

Zhang, Zhe; Li, Chengjiang

doi:10.1590/s0004-27302013000800013

Arq Bras Endocrinol Metab

2013

DOI: 10.1590/s0004-27302013000800013

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Follow-up of a case of subacute thyroiditis with uncommon thyroid 99mTc uptake

Zhe Zhang

Chengjiang Li

Abstract: Thyroidal 99mTc uptake in the acute thyrotoxic phase of subacute thyroiditis (SAT) is always inhibited. However, a patient with SAT had signs in the right-side thyroid gland with transient thyrotoxicosis and slightly high 99mTc uptake levels in the right lobe, low 99mTc uptake in the left lobe, and normal overall uptake. Histological examination showed cellular destruction and granulomatous inflammatory changes in the right lobe, with marked interstitial fibrosis in the left lobe. The patient was thyrotrophin-… Show more

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Cited by 2 publications

References 11 publications

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Identifying the Lowest Effective Initial Dose of Prednisolone for the Treatment of Subacute Granulomatous Thyroiditis: A Systematic Review and Meta-Analysis

Soltani

Nourani

Roudsari

et al. 2022

CRCEP

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Background: Subacute granulomatous thyroiditis (SAGT) is an inflammatory disease due to viral infections. Glucocorticoids, especially prednisolone (PSL), are one of the first approaches in the treatment of patients with SAGT. To date, no study has determined the lowest effective dose of prednisolone with the lowest recurrence rate in the treatment of SAGT. This study aimed to use meta-analysis methods to identify the appropriate dosage of prednisolone with the lowest recurrence rate in the treatment of patients with SAGT. Methods: This study was conducted according to the PRISMA checklist in February 2021. Two independent researchers performed a search for relevant literature published before March 2021 in English databases including Scopus, MEDLINE (via PubMed), Web of Science, Cochrane Library, Google Scholar, EMBASE, and also Persian electronic databases including SID, Iran medex, Magiran, and Irandoc. The search algorithm was initially developed by using a combination of MeSH terms, keywords, and also Boolean operators (“AND”; “OR”; “NOT”): Subacute thyroiditis, De Quervain Thyroiditis, Glucocorticoids, Prednisolone, Recurrence, and Meta-Analysis. All statistical analyses were performed using STATA 15.0 (StataCorp LLC, College Station, TX, USA) and SPSS 17.0. A random-effects model based on Metaprop were applied for the Meta-analysis. To assess heterogeneity between studies, the chi-squared test and I2 index were used, and for evaluating publication bias, funnel plots and Egger tests were performed. Results: The overall recurrence rate was 14.72% [95% CI: 9.63- 20.58] and there was a significant heterogeneity among the studies [I2 = 69.56%; P=0.000]. To evaluate the lowest effective dose of prednisolone, we divided the studies into two groups based on the mean initial dose of prednisolone: less than or equal to 20 mg/day (group one) and greater than 20 mg/day (group two). The recurrence rate in group 1 was 11% [95% CI: 5.7- 16.2] and in group 2 was 23.6% [95% CI: 11.5- 35.6]. Significant correlations were observed between the initial mean dose of PSL and recurrence rate (r= 0.71; P= 0.013). Begg’s funnel plot there was no evidence of publication bias in these studies (p=0.160). Conclusion: According to the results of this meta-analysis, 15 to 20 mg/day of prednisolone is the most effective dosage with the lowest recurrence rate in the treatment of subacute Granulomatous thyroiditis.

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Identifying the Lowest Effective Initial Dose of Prednisolone for the Treatment of Subacute Granulomatous Thyroiditis: A Systematic Review and Meta-Analysis

Soltani

Nourani

Roudsari

et al. 2022

CRCEP

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Recurrent Subacute Thyroiditis Lacking Diagnostic Imaging Features: Atypical Scenario

Rashid

Farooq

Kiran

et al. 2017

AACE Clinical Case Reports

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Objective: A diagnosis of subacute thyroiditis (SAT) is based on history and clinical features supported by laboratory investigations and imaging studies. However, the presence of SAT with normal thyroid scintigraphy findings is exceedingly rare.Methods: We report the history, exam findings, laboratory results, and imaging studies of a 51-year-old postmenopausal female with SAT.Results: The patient had a history of recurrent SAT 10 years back and presented now with pain in her neck for 1.5 months, fever for 3 days, heat intolerance, sleep disturbances, and restlessness. Physical examination revealed enlargement and marked tenderness over the thyroid. Thyroid profile showed thyroid-stimulating hormone (TSH) 0.023 µIU/mL (normal, 0.4 to 4.2 µIU/mL), free thyroxine (FT4) 2.31 ng/dL (normal, 0.89 to 1.76 ng/dL), and free triiodothyronine (FT3) 2.74 ng/dL (normal, 1.3 to 3.1 ng/dL). Tc-99m pertechnetate scintigraphy showed bilateral normal homogenous uptake in both lobes of the thyroid. Patient was started on 1 tablet carbimazole 5 mg three times daily, but she returned 2 weeks later with persistence of symptoms. Repeat labs showed TSH, 0.008 µIU/ mL; FT4, 2.64 ng/dL; and FT3, 2.5 ng/dL, with erythrocyte sedimentation rate (ESR) of 94 mm/hour (normal, 0 to 20 mm/hour). Carbimazole was stopped and prednisolone was started in tapering doses for 6 weeks. Improvement in symptoms with normalization of ESR to 8 mm/hour and FT4 to 1.04 ng/dL occurred after taking prednisolone for 6 weeks at follow-up.Conclusion: This patient presenting with typical clinical features of SAT and elevated ESR but lacking the characteristic imaging thus emphasizes diagnosis of SAT on the basis of history, physical examination, and laboratory data, even if thyroid scintigraphy findings are not in favor of disease. (AACE Clinical Case Rep. 2017;3:e66-e69) Abbreviations: ESR = erythrocyte sedimentation rate; FT4 = free thyroxine; SAT = subacute thyroiditis; TSH = thyroidstimulating hormone

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Follow-up of a case of subacute thyroiditis with uncommon thyroid 99mTc uptake

Cited by 2 publications

References 11 publications

Identifying the Lowest Effective Initial Dose of Prednisolone for the Treatment of Subacute Granulomatous Thyroiditis: A Systematic Review and Meta-Analysis

Identifying the Lowest Effective Initial Dose of Prednisolone for the Treatment of Subacute Granulomatous Thyroiditis: A Systematic Review and Meta-Analysis

Recurrent Subacute Thyroiditis Lacking Diagnostic Imaging Features: Atypical Scenario

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