Case Report

Fever of Unknown Origin as a Sole Presentation of Subacute Thyroiditis in an Elderly Patient: A Case Report with Literature Review

Table 2

Summary of case reports with subacute thyroiditis (SAT) and fever of unknown origin (FUO).

Author/YearAge/SexSummary

Weiss et al, 2000 [8]81/M(i) Fever, confusion, and bilateral lower extremity weakness.
(ii) TSH 0.02 mIU/ml, FT4 3.1 ng/dL, FT3 6.0 pg/mL, and ESR 98 mm/hr
(iii) Treated with Beta-blocker.
(iv) Profound hypothyroidism at 3 months and euthyroid at 14 months.

Alexander et al, 2009 [9]43/M(i) Fever, weight loss and neck pain
(ii) Treated with NSAIDs, beta-blockers and steroids
(iii) Hypothyroidism on follow-up

Cunha et al, 2010 [10]55/F(i) Fever, chills, and night sweats, weight loss, fatigue, headaches, and jaw angle pain.
(ii) Elevated ESR 98 mm/hr and CRP 84.5 mg/L
(iii) Suspicion for Temporal arteritis but later found to have SAT.
(iv) Elevated Ferritin levels 611 ng/mL (n = 10-291 ng/mL)
(v) Suppressed TSH 0.009 mIU/mL, with elevated free T4 2.13 ng/dL and TBG antibody 332 IU/ mL
(vi) FNA confirmed diagnosis of de Quervain’s subacute thyroiditis

Karachalios et al, 2010 [11]72/M(i) Fever, neck pain, headache and weakness
(ii) ESR 130 mm/hr, CRP 52 mg/dl
(iii) Suppressed TSH 0.024 mIU/mL, elevated T4 185 nmol/l and normal T3 2.5 nmol/l
(iv) TBG antibody and TPO antibody negative
(v) Treated with Prednisone 10 mg daily for 2 weeks
(vi) Asymptomatic at 2 weeks

Kim et al, 2013 [12]48/F(i) Fever, neck pain and history of URI 7 weeks prior
(ii) Suppressed TSH 0. 065 μ IU/mL, elevated ESR 65 mm/h and CRP 2.07 mg/dL
(iii) Treated with low-dose steroid (prednisone, 10 mg per day)
(iv) Hypothyroid at 3 week with TSH 56.81 μIU/mL and FT4 0.21 ng/dL.

Muqtadir et al, 2015 [13]40/M(i) Fever
(ii) Elevated ESR 90 mm/h
(iii) Suppressed TSH 0.02 mIU/mL and elevated FT4 3.66 ng/dL
(iv) Negative TRAB and anti- TPO antibodies
(v) US thyroid showed hypoechoic, heterogenous thyroid gland.
(vi) Low radioactive iodine uptake (RAIU)
(vii) Treated with Prednisone 10mg per day for 10 days.
(viii) Hypothyroid at 3 week follow up.

Dalugama, 2018 [14]42/M(i) Fever, neck tenderness, cervical lymphadenopathy, anorexia, weight loss
(ii) Raised ESR 80mm/hr and CRP 112 mg/L
(iii) Suppressed TSH 0.012 mIU/mL with elevated free T4 42.08 pmol/L and Free T3 8.71 pmol/L
(iv) FNA - clustered epithelioid cells, scattered lymphocytes, and multinucleated giant cells
(v) Treated with Prednisone 10 mg daily for 7 days
(vi) Euthyroid at 1 month.