Thursday, January 6, 2011

Nuclear

A 40 year old woman who complains of neck pain radiating to the jaw, sweating, palpitations, weight loss, and malaise. On exam, you palpate a diffuse tender mildly enlarged goiter. Review of systems is positive for a recent upper respiratory tract infection. She has a mild anemia and leukocytosis. ESR is markedly elevated. You schedule a nuclear exam for her, which is shown below.

By the time the patient follows up after the test, she says her symptoms have changed completely. Now, she is feeling depressed, lethargic, cold, and constipated.

Challenge: What's your diagnosis?

Image shown under Fair Use.

3 comments:

Easy said...

Subacute Thyroidits

Michelle said...

de quervain's thyroiditis?

Craig Chen said...

whoops! sorry about that, i got way behind, but yes you are correct!
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Nuclear

This is subacute thyroiditis (also called subacute granulomatous or nonsuppurative thyroitidtis, giant cell thyroiditis, De Quervains' thyroiditis). It is presumably caused by a viral infection or post-viral process. The Tc-99m pertechnetate scan shows poor uptake in the thyroid consistent with the diagnosis. There is a small focus of tracer uptake in the right upper pole representing an autonomous nodule as well.

Sources: UpToDate; med.harvard.edu.