Question:
A patient following URTI develops a painful neck swelling and is diagnosed with granulomatous thyroidits. What is the next step in the management of the patient?
A patient following URTI develops a painful neck swelling and is diagnosed with granulomatous thyroidits. What is the next step in the management of the patient?
Show Hint
Painful thyroid following a viral infection = De Quervain's (Subacute granulomatous) thyroiditis. Treatment: NSAIDs first, steroids only if refractory. Anti-thyroid drugs are useless here.
Updated On: Sep 3, 2026
- Symptomatic treatment
- Oral steroids
- Thyroidectomy
- Tamoxifen
Show Solution
Verified By Collegedunia
The Correct Option is A
Solution and Explanation
Concept:
A patient presents with an acutely painful thyroid gland following a recent viral Upper Respiratory Tract Infection (URTI), a classic presentation for Subacute Granulomatous Thyroiditis.
The clinical task is to select the appropriate first-line therapy, keeping in mind the inherently self-limiting nature of this inflammatory condition.
Explanation:
• Subacute Granulomatous Thyroiditis, also widely known as De Quervain's thyroiditis, is an acute, painful inflammatory condition of the thyroid gland strongly believed to be triggered by a viral infection (such as Coxsackievirus, Mumps, or Adenovirus).
• It classically presents with a distinctly tender, firm, and enlarged thyroid gland (painful goiter), accompanied by systemic symptoms like fever and malaise. The inflammation causes the leakage of preformed thyroid hormones, leading to a transient, mild thyrotoxicosis, which is eventually followed by a hypothyroid phase, before finally returning to euthyroidism.
• Because De Quervain's thyroiditis is a temporary, spontaneously remitting, and strictly self-limiting viral/post-viral process, aggressive medical or surgical interventions are generally unwarranted.
• The absolute first-line and most appropriate initial step in management is pure symptomatic treatment. This consists of prescribing high-dose NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) or Aspirin to aggressively manage the neck pain and reduce glandular inflammation.
• Oral corticosteroids (Option B), such as Prednisone, are strictly reserved as a second-line therapy for severe, debilitating cases that are completely refractory to maximum doses of NSAIDs. They are not the immediate next step for a typical presentation.
• Thyroidectomy (Option C) has absolutely no role in the management of this self-limiting, non-neoplastic viral condition. Anti-thyroid medications (like Methimazole) are also ineffective because the thyrotoxicosis is due to hormone leakage, not hyper-synthesis.
Final Answer:
The condition is self-limiting; thus, the primary and most appropriate immediate management is symptomatic treatment with pain relievers and NSAIDs.
A patient presents with an acutely painful thyroid gland following a recent viral Upper Respiratory Tract Infection (URTI), a classic presentation for Subacute Granulomatous Thyroiditis.
The clinical task is to select the appropriate first-line therapy, keeping in mind the inherently self-limiting nature of this inflammatory condition.
Explanation:
• Subacute Granulomatous Thyroiditis, also widely known as De Quervain's thyroiditis, is an acute, painful inflammatory condition of the thyroid gland strongly believed to be triggered by a viral infection (such as Coxsackievirus, Mumps, or Adenovirus).
• It classically presents with a distinctly tender, firm, and enlarged thyroid gland (painful goiter), accompanied by systemic symptoms like fever and malaise. The inflammation causes the leakage of preformed thyroid hormones, leading to a transient, mild thyrotoxicosis, which is eventually followed by a hypothyroid phase, before finally returning to euthyroidism.
• Because De Quervain's thyroiditis is a temporary, spontaneously remitting, and strictly self-limiting viral/post-viral process, aggressive medical or surgical interventions are generally unwarranted.
• The absolute first-line and most appropriate initial step in management is pure symptomatic treatment. This consists of prescribing high-dose NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) or Aspirin to aggressively manage the neck pain and reduce glandular inflammation.
• Oral corticosteroids (Option B), such as Prednisone, are strictly reserved as a second-line therapy for severe, debilitating cases that are completely refractory to maximum doses of NSAIDs. They are not the immediate next step for a typical presentation.
• Thyroidectomy (Option C) has absolutely no role in the management of this self-limiting, non-neoplastic viral condition. Anti-thyroid medications (like Methimazole) are also ineffective because the thyrotoxicosis is due to hormone leakage, not hyper-synthesis.
Final Answer:
The condition is self-limiting; thus, the primary and most appropriate immediate management is symptomatic treatment with pain relievers and NSAIDs.
Was this answer helpful?
0
0
Top NEET SS Surgical Questions
- A post-mastectomy patient (for malignant breast lump) who also had axillary lymph node dissection now presents in the postoperative period (after drain removal) with a soft, fluctuant swelling in the axilla extending into the mastectomy site.
- A patient presents with a large, multilobulated breast tumour clinically suggestive of phyllodes tumour, and there is a significant family history of breast cancer (grandmother) and prostate cancer (father). What is the next step in management?
- In a young woman with a breast lump confirmed on ultrasound to be a simple cyst, what is the next step in management?
- A 45-year-old woman underwent investigations for a breast lump. Her biopsy report confirms invasive ductal carcinoma of the breast. You are the surgical resident in charge and need to communicate the diagnosis to her. What is the most appropriate approach?
- A 35-year-old woman, a chronic smoker, presents with recurrent painful periareolar swelling and purulent nipple discharge for the past 6 months. She has undergone incision and drainage twice, but the symptoms recur after a short period. Which of the following statements about the most likely diagnosis is true?
View More Questions
Top NEET SS Endocrine and Thyroid Surgery Questions
- A female with a known slow-growing papillary thyroid carcinoma presents with a rapid increase in size of the swelling over one month along with hoarseness of voice. Which malignancy would it most likely have progressed to?
- A patient presents with clinical features of Hashimoto thyroiditis. Which of the following cancers is most commonly associated with Hashimoto thyroiditis?
- A surgeon is performing thyroid surgery but is unable to achieve adequate exposure. He requests a retractor. Which retractor should you hand him?
- A patient presents with a large, smooth thyroid mass arising from both lobes in the front of the neck. There are no compressive symptoms. FNAC shows no features of malignancy, but the patient is concerned about cosmetic appearance. What is the next step?
- A patient is diagnosed with medullary thyroid carcinoma (MTC). Which syndrome is most commonly associated with MTC?
View More Questions
Top NEET SS Questions
- A liver transplant patient presents with diarrhoea, colitis, a total leukocyte count of 1800, and a positive blood CMV PCR. What is the next step in management?
- A 32-year-old male recovering from dengue fever initially showed clinical improvement but now presents with recurrence of high-grade fever, fatigue, and pancytopenia on day 10 of illness. He is hemodynamically stable with no bleeding manifestations. Which of the following investigations should be performed first to evaluate the cause of relapse and cytopenia?
- A 48-year-old man with chronic hepatitis C infection is being evaluated for risk factors associated with progression of liver disease. He has a 20-year history of infection, drinks alcohol occasionally, and has a high serum HCV RNA viral load. Which of the following factors is not associated with an increased risk of progression of liver disease in chronic HCV infection?
- A 28-year-old veterinary worker who previously received a full 3-dose pre-exposure rabies vaccination series is bitten by a stray dog while handling an animal in the clinic. The wound is cleaned immediately. What is the most appropriate post-exposure management?
- A 42-year-old patient undergoing chemotherapy for acute myeloid leukemia develops neutropenia (ANC $<$ 500) and is treated with broad-spectrum antibiotics. After initial recovery of neutrophil counts (ANC = 1500), he again develops high-grade fever and right upper quadrant abdominal pain. Imaging shows multiple small hypodense lesions in the liver and spleen. What is the most likely diagnosis?
View More Questions