Clinical Course and Outcome (continued)

The patient's thyroid hormone levels returned to normal shortly after treatment with glucocorticoids was begun (Figures 3,4, and 5). A biopsy of the left temporal artery showed disruption of the internal elastic lamina, fibrous thickening, and elements of healing inflammation. The patient received prednisone 60 mg by mouth daily, and the dose was tapered gradually over 2 months. This pathologic and clinical presentation is consistent with a diagnosis of giant cell or temporal arteritis occurring concomitantly with subacute thyroiditis. Ninety days after initial presentation to the emergency room, the patient was completely free of symptoms on no medications. TSH, thyroid hormone levels, ESR, and thyroid gland size returned to normal.

Thyroid-Stimulating Hormone (TSH).

Erythrocyte Sedimentation Rate (ESR).

Total and Free Thyroxine (T4).


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