Fever, neck pain, sore throat, palpitations... Be careful! Don't misdiagnose this disease as a "cold"

Recently, a young professional woman, who is usually busy with work, had repeated fevers in the past 20 days, accompanied by neck pain, sore throat, bad temper, palpitations and discomfort. The patient always thought that she had a "cold". After the use of antibiotics and antiviral drugs, the patient's condition did not improve significantly, and she still had repeated fevers, and the pain in the anterior neck radiated to the ears. After being admitted to the Respiratory Department of the Second People's Hospital of Hunan Province (Provincial Brain Hospital) , the doctor found that the patient's thyroid gland was significantly enlarged. After completing a series of related examinations, it was found that the erythrocyte sedimentation rate was high and the thyroid hormone level was high. After consultation with Director Zhang Haitao of the Metabolic Endocrinology Department (including the Nutrition Department) , it was diagnosed as subacute thyroiditis. Then she was transferred to the department for hormone conditioning treatment.

Director Zhang Haitao introduced that subacute thyroiditis is a non-bacterial infectious disease of the thyroid gland, characterized by transient, painful, destructive thyroid tissue damage accompanied by a systemic inflammatory response. It is the most common painful thyroid disease.

The disease has obvious seasonality, with a high incidence in winter and spring. The incidence rate is high in young and middle-aged women aged 30-50, 3-6 times that of men. It is mostly caused by viral infection or allergic reaction after viral infection. There are often symptoms of viral pharyngitis, mumps, measles or other viral infections 1-3 weeks before the onset of the disease. The woman had a history of pharyngitis 2 weeks before the onset of the disease, which is considered to be the cause of the disease.

The main clinical manifestations of subacute thyroiditis are: (1) systemic symptoms of acute inflammation such as fever, muscle aches, palpitations, and sweating. (2) Obvious pain in the thyroid area, which may radiate to the back of the ear. (3) Abnormal thyroid function, thyrotoxicosis, hypothyroidism, and recovery. Therefore, thyroid hormone levels need to be closely monitored and appropriate treatment should be given at different times.

So, how to treat subacute thyroiditis? Subacute thyroiditis is an allergic inflammation caused by viral infection rather than bacterial infection, so antibiotic treatment is ineffective.

The first choice for treatment of mild patients is antipyretic analgesics, such as ibuprofen and diclofenac sodium; while patients with severe systemic symptoms, ineffective non-steroidal anti-inflammatory drugs, and severe thyroid enlargement and pain need to be treated with glucocorticoids such as prednisone, which can reduce the inflammatory response and relieve fever and thyroid enlargement and pain symptoms.

The woman had severe systemic reactions, thyroid pain, and was in the thyrotoxicosis stage. After the endocrinologist gave her hormones and heart rate-slowing drugs, her symptoms were significantly relieved.

Therefore, Director Zhang Haitao reminds everyone that subacute thyroiditis is easily confused with upper respiratory tract infection. If you have a fever for a long time, accompanied by thyroid pain and thyroid enlargement, do not think it is just a common cold. Do not blindly use anti-infection drugs. It is recommended to go to the hospital for a careful examination in time. Only with targeted treatment can you recover better!

Hunan Medical Chat Special Author: Xie Lingyan, Department of Endocrinology, Hunan Second People's Hospital (Provincial Brain Hospital)

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(Edited by YT)