Endocrine Abstracts

JOINT3619

Introduction: Subacute thyroiditis of Quervain is an acute inflammatory condition of the thyroid, most likely triggered by a viral infection. Its prevalence is estimated to be around 0.1% to 0.5% of the general population, making it relatively rare compared to other types of thyroiditis.

Case report: A 55-year-old female patient with no significant medical history who presented with a cervical swelling. Ultrasound examination revealed a thyroid nodule classified as EUTIRADS 4, with a Bethesda II on fine-needle aspiration cytology. In June 2024, the patient developed flu-like symptoms followed by the onset of a painful, vascular goiter in the context of a febrile illness. Laboratory investigations showed an inflammatory syndrome with a CRP of 179, and hyperthyroidism (TSH 0.02 mIU/l, FT4 36 pmol/l). The patient was treated with anti-inflammatory drugs for one month, resulting in significant improvement of the pain. Subsequent tests two months after the first episode revealed a hypothyroidism with a TSH of 87 mIU/l and FT4 of 3.6 pmol/l. Ultrasound imaging confirmed the presence of a goiter with features suggestive of acute thyroiditis. Levothyroxine therapy was initiated. Six months after this episode, the patient re-presented with the same plaints: bilateral neck pain and odynophagia. Examination revealed a tender goiter, with a CRP of 92 and an elevated erythrocyte sedimentation rate (ESR) of 91 mm/h and a TSH level at 13 mUI/l, confirming the recurrence of the Subacute thyroiditis.

Conclusion: The Quervain’s thyroiditis typically follows a course of three phases: an initial hyperthyroid phase, followed by a hypothyroid phase, and eventual spontaneous recovery within two to three months, with recurrence being rare, occurring in only 1.4% to 10% of cases. These recurrences are mainly due to the inflammatory origin of this pathology, the underlying inflammation may persist or reactivate, potentially causing a recurrence of the disease. Additionally, factors such as genetics, the immune system, and recurrent viral infections could contribute to this reactivation.