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

Abstract

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.

Two Important Issues in Subacute Thyroiditis Management: Delayed Diagnosis and Inappropriate Use of Antibiotics

“…In the literature, recent studies have focused on the diagnosis and treatment modalities of SAT. The delays in the prediagnosis period of the disease and its consequences have been presented in only one recent study [12].…”

“…The prediagnosis period was prolonged up to 70 days in some patients. Also, Stasiak et al [12] reported a delay of >2 weeks in SAT diagnosis in 73% of 64 patients. The pain radiating up to the ear/jaw was observed in 71% of the patients.…”

“…Stasiak et al [12] reported that unnecessary antibiotic use was seen in 46.7% of SAT patients, and patients who received antibiotics had more fever symptoms, more suppressed TSH, and elevated fT4, fT3, WBC, and CRP levels. However, in the current study, there was no significant difference between the groups in terms of symptoms and laboratory findings, which could be attributed to the larger sample size of the current study.…”

“…The results of the present study demonstrated that the tendency of the clinician to prescribe erroneously antibiotics in patients with SAT lies in the lack of awareness of the diagnosis of SAT in the differential diagnosis rather than high acute-phase reactants or severity of the clinical features. Also, Stasiak et al [12] claimed that there was no difference in the diagnosis delay between the groups that received and did not receive antibiotics ( p = 0.57). However, in the current study, it was shown that unnecessary use of antibiotics causes a delay in the diagnosis of SAT patients as expected.…”

Subacute Thyroiditis is Associated with HLA-B*18:01, -DRB1*01 and -C*04:01—The Significance of the New Molecular Background

“…Subacute thyroiditis is a rare disease but its incidence is increasing. Many clinical symptoms of SAT are not characteristic, and diagnosis is often delayed, with many previous misdiagnoses and mistreatments being reported [24]. The data in the literature indicate that the occurrence of SAT is associated with genetic predispositions encoded in the sixth chromosome fragment responsible for the HLA tissue compatibility antigen system.…”