Abstract

Seow Chu Ee* and Lee Ze Chen

Transient hyperthyroidism can be part of the presentation for subacute thyroiditis, with a classic triphasic course (thyrotoxicosis, hypothyroidism, recovery). This is a case of a 46 year old male diagnosed with Human Immunodeficiency Virus (HIV) infection on Highly Active Antiretroviral Therapy (HAART), presented with prodrome of fever and malaise, followed by sore throat and tender, swollen thyroid. He had hyperthyroid symptoms on initial presentation as well. Thyroid function test showed hyperthyroidism. Inflammatory markers Erythrocyte Sedimentation Rate (ESR) and C Reactive Protein (CRP) were elevated. Ultrasound neck excluded presence of collection, thyroid scintigram revealed significant reduce tracer uptake within the thyroid region, consistent with diagnosis of subacute thyroiditis. He was treated with T Ibuprofen and oral Propranolol. Hyperthyroid symptoms, fever, thyroid pain and swelling were resolved in subsequent clinic review, with latest thyroid function test showing hypothyroidism. It is crucial to identify subacute thyroiditis with thyroxicosis as the initial presentation. This is because the management is different from other causes hyperthyroidism, where antithyroid drug is always unnecessary in managing the transient thyrotoxicosis.