Which physical findings are characteristic of subacute granulomatous thyroiditis?

Updated: Mar 23, 2021
  • Author: Stephanie L Lee, MD, PhD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Patients often present with an acute, viruslike illness characterized by high, spiking fever; malaise; myalgia; fatigue; and prostration.

Thyroid pain is usually symmetrical. In 30% of cases, however, it starts on one side and then migrates contralaterally within a few days. While the pain may be limited to the region of the thyroid, it may also involve the upper neck, throat, jaw, or ears. In many patients, the pain is so severe that he or she cannot tolerate palpation of the neck. The pain may be intense enough to prevent the swallowing of saliva, liquids, and food.

Thyroid enlargement, however, is usually symmetrical and mild, occasionally with areas of localized firmness. Erythema and hyperesthesia of the overlying skin may be present at the onset of severe cases. Cervical lymphadenopathy is uncommon. Lid retraction is rare, and exophthalmos does not occur.

Thyroid hormone levels are often extremely elevated, resulting in marked signs and symptoms of thyrotoxicosis. Cases of lesser severity also exist, and the etiology may be confusing.

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