Thursday, January 24, 2013

Female With Acutely Painful Goiter

Clinical Vignette: A 40-year-old female with no prior history of thyroid disease, presents with a 5 day history of an acutely painful, left-sided goitre. Clinically she appeared euthyroid, and was apyrexial.
Investigations revealed the following:

  • Haemoglobin 13.0 g/dL
  • White cell count 7.0 x 109/l
  • Platelets count 200,000/mm3
What is the most likely diagnosis?
  1. De Quervain's thyroiditis
  2. Haemorrhage into a cyst
  3. Hashimoto's thyroiditis
  4. Staphylococcal abscess
  5. Thyroid carcinoma

Answer to clinical vignette|case: (2)

The left side of this patient's goitre becomes acutely swollen with no other signs and FBC is normal which suggests acute haemorrhage into a cyst.
Thyroid cancer is usually painless.
De Quervain's thyroiditis is a diffusely tender goitre typically with systemic features such as weight loss, pyrexia and a raised ESR.