Time-lag between symptom onset and laboratory findings in patients with subacute thyroiditis

Tachibana, Tomoyasu; Orita, Yorihisa; Ogawara, Yuya; Matsuyama, Yuko; Abe, Iku; Nakada, Michihiro; Sato, Yasuharu; Nishizaki, Kazunori

doi:10.1016/j.anl.2013.11.003

Cited by 10 publications

(10 citation statements)

References 14 publications

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“…Other authors also reported high frequency of delayed SAT diagnosis [5][6][7][13][14][15]. Some of them claim that this fact is related to the delay in the appearance of abnormalities in the laboratory results as compared to the onset of clinical symptoms [16,17]. Nishihara at al.…”

Section: Discussionmentioning

confidence: 99%

“…reported that elevated FT3, FT4, CRP levels peaked within 7 days from the symptom onset, and TSH suppression was observed even later [16]. Tachibana et al described a group of 5 patients (3 patients with confirmed SAT and 2 -with suspected unconfirmed SAT) in whom TSH and FT4 alterations were observed after more than 6 weeks from the symptom onset [17]. However, it should be underlined that in the remaining 22 SAT patients de- scribed by these authors, the abnormalities in CRP and thyroid hormones were present at the very beginning of the disease [17].…”

Section: Discussionmentioning

confidence: 99%

“…Tachibana et al described a group of 5 patients (3 patients with confirmed SAT and 2 -with suspected unconfirmed SAT) in whom TSH and FT4 alterations were observed after more than 6 weeks from the symptom onset [17]. However, it should be underlined that in the remaining 22 SAT patients de- scribed by these authors, the abnormalities in CRP and thyroid hormones were present at the very beginning of the disease [17]. It is well known that in some patients with mild course of the disease, no abnormalities can be observed in thyroid hormone levels orrarely -even in CRP.…”

Section: Discussionmentioning

confidence: 99%

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Time-Lag Between Symptom Onset and Diagnosis of Subacute Thyroiditis – How to Avoid the Delay of Diagnosis and Unnecessary Overuse of Antibiotics

et al. 2019

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Clinical symptoms of subacute thyroiditis (SAT) may be misleading and the proper diagnosis is significantly delayed, and many unnecessary therapeutic methods are used, including application of antibiotics. The purpose of the study is to analyze the reasons and frequency of delayed SAT diagnosis and unnecessary antibiotic treatment and to propose a simple algorithm to facilitate the diagnosis and prevent antibiotic abuse. Sixty-four SAT patients were divided into groups depending on the period of time from the first symptoms of SAT to diagnosis and on the unnecessary use of antibiotics. Data from medical history and laboratory test results were analyzed for individual groups to determine the reasons for delayed diagnosis and incorrect treatment. In 73% of patients, the diagnosis was delayed from over two weeks up to six months. Among 62 patients who provided data on antibiotic use, 29 (46.77%) were treated with one or more antibiotics due to SAT symptoms. Fever, preceding infection, increased C-reactive protein (CRP), and WBC were characteristic for the antibiotic treated group. Fever, preceding infection, increased CRP and WBC are typical for both SAT and infection and are the main symptoms leading to misdiagnosis and unnecessary antibiotic treatment in SAT. Thus, in all patients with neck pain or other SAT-like symptoms, thorough clinical examination of the neck is mandatory. When firm and/or tender thyroid nodule/goitre is present and erythrocyte sedimentation rate /CRP is increased, patient should be promptly referred to an endocrinologist, and antibiotics are not recommended.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Time-Lag Between Symptom Onset and Diagnosis of Subacute Thyroiditis – How to Avoid the Delay of Diagnosis and Unnecessary Overuse of Antibiotics

et al. 2019

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“…Predominant hypoechoic lesions of the thyroid on USG reported by Tachibana et al . [ 20 ] and Frates et al . [ 21 ] were seen in only 46.9% of patients in this study.…”

Section: Discussionmentioning

confidence: 99%

Technetium-99m thyroid scintigraphy and human leukocyte antigen – B35 in sub-acute thyroiditis

et al. 2018

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Introduction:Sub-acute thyroiditis possibly caused by a viral infection of thyroid gland is associated with a surge in thyroxine levels of the patient. Women in the younger age group are affected more than men. Markedly decreased radioactive iodine thyroid uptakes in a setting of thyrotoxicosis associated with elevated thyroxine levels and reduced thyroid stimulating hormone levels usually clinches the diagnosis. Patients mostly require symptomatic treatment with non-steroidal anti-inflammatory drugs. Sub-acute thyroiditis is a self-limiting disorder with most of the patients making a complete recovery in a span of three to six months. Being geographically and ethnically different the present studies was undertaken with an objective of understanding the clinical, laboratory and thyroid uptake profiles in patients of SAT during its natural history and also find the extent of genetic influences through its association with HLA B35.Materials and Methods:32 patients in the age group of 20-59 years diagnosed to have sub-acute thyroiditis were studied. 18 patients out of 32 were subjected to HLA B35 testing. Other laboratory parameters that included hormonal profile and radioactive thyroid uptakes were performed.Results:Most of the patients were females and in their fourth decade of life. Thyroid stimulating hormone levels were decreased in 32 (100%). A majority of patients had normal anti TPO levels. All the patients had grossly decreased Tc-99m thyroid uptake levels at presentation. HLA B35 test done in 18 patients was reported positive in 10 (55.56%) patients.Conclusion:The present study is unique in having used serial Tc-99m thyroid scintigraphy in patients of SAT. A positive HLA B 35 is associated in a majority of patients conferring genetic susceptibility.

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“…However, patients may come to hospital at any stage, and the clinical manifestations may not show in a typical way, which makes the diagnosis more difficult. Furthermore,a study showed most laboratory results associated with thyrotoxicosis have reached abnormal levels within 3 weeks after onset.But longer time-lags could existed between the onset of clinical symptoms and the appearance of abnormal laboratory findings in patients with SAT[9].Therefore,hyperthyroidism and suppressed uptake of Technetium-99 m (99 m-Tc) or 131I at the same time play a significant role in diagnosing. However, the radioisotope scanning is not always available in every hospital and sometimes it is contraindicated in specific situations such as in pregnant or lactating women.…”

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confidence: 99%

Establishing a diagnostic scale of subacute thyroiditis without radioisotope scanning

Xiong

Luo

Wang

et al. 2020

Preprint

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Background: Radioisotope scanning is important to diagnose subacute thyroiditis(SAT),but it’s not always available.So we aim to establish a diagnostic scale for SAT without radioisotope scanning. Methods: The suspected SAT patients hospitalized in Yuebei people's Hospital from January 2012 to December 2016 were selected and divided into study group and control group according to whether they were diagnosed as SAT. The clinical indexes of two groups were collected and the diagnostic scale of SAT was established by using binary logistic regression analysis.The effectiveness of the scale was evaluated by ROC curve. Results: Of 261 patients,69% of patients were confirmed with SAT and the remaining 31% of patients were not diagnosed with SAT. After univariate analysis,variables which were considered statistically different( P <0.05) between the two groups were selected as independent variables and the diagnosis of SAT was taken as dependent variable in the binary logistic regression model. The logistic regression model consisted of 4 variables, each was thyroid tenderness,firm on palpation, increased ESR and hyperthyroidism.The P value of Omnibus tests was ≤0.001 and the Nagelkerke R Square was 0.894. The diagnostic scoring scale was established with these four variables according to their regression coeffient.The area under the ROC curve for this diagnostic scale was 0.989(95% confidence interval, 0.978-1.0).The highest Youden index was 0.908,the corresponding cut-off point was 5.5.Internally validation shows a sensitivity of 93.33% and a specificity of 97.53% of our scale. Conclusions: We established and validated a diagnostic scale for SAT without the need for radioisotope scanning for the first time.It has good application in institutions that do not have radioisotope machines or among pregnant and lactating women.

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Time-lag between symptom onset and laboratory findings in patients with subacute thyroiditis

Cited by 10 publications

References 14 publications

Time-Lag Between Symptom Onset and Diagnosis of Subacute Thyroiditis – How to Avoid the Delay of Diagnosis and Unnecessary Overuse of Antibiotics

Time-Lag Between Symptom Onset and Diagnosis of Subacute Thyroiditis – How to Avoid the Delay of Diagnosis and Unnecessary Overuse of Antibiotics

Technetium-99m thyroid scintigraphy and human leukocyte antigen – B35 in sub-acute thyroiditis

Establishing a diagnostic scale of subacute thyroiditis without radioisotope scanning

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