Case Report

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

Table 3

Summary of retrospective studies in various parts of world regarding epidemiology, clinical characteristics, treatment, and outcomes.

Author/ YearLocationResults

Fatourechi
Et al, 2003 [1]
Minnesota, USA
(1960-1997)
N= 160 patients (F:M ratio 3:5), mean age 46 yr (range, 14–87 yr)
Incidence 4.9 cases per 100,000/yr
Clinical presentation
 (i) URI within 30 days in 20 (21%) and in 30-90 days in 4 (4.2%) patients respectively.
 (ii) Neck pain was most common symptom in 90/94 patients (96%) with radiation to jaw and ear in 12 and 18 patients respectively
 (iii) Less common symptoms - dysphagia in 30, myalgia in 12, tremor in 19, sweating in 22 & weight loss in 15 patients.
Treatment
 (i) NSAIDs alone in 39 (41%) patients
   NSAIDs alone or NSAIDs + corticosteroids in 57 (61%) patients
 (ii) Corticosteroids in 34 (36%) patients.
 (iii) Thyroidectomy in 1 patient.
Permanent hypothyroidism in 15% cases at end of 28 years.
Recurrence rate 4% (with interval being from 6-21 years).

Benbassat et al, 2007 [4]Israel
(1999-2005)
N= 56 (Mean age 48.6+/-12 yr.
Median disease duration 77 days.
Treatment:
 (i) No treatment 5/ 56 patients.
 (ii) NSAID 43/56 patients.
 (iii) Steroids 25/56 patients.
Follow up
 (i) Transient hypothyroidism 25/56 patients.
 (ii) Permanent hypothyroidism in 6/56 patients.
Recurrence Rate 9%

Erdem et al, 2007 [15]Turkey
(1987-2001)
N= 176 (134 F and 35 M); mean age 34.0+/-17.8 yr
Clinical presentation:
 (i) Thyroid pain in 97.1% of female patients & in 100% of male patients.
 (ii) Fever in 46% of patients.
Laboratory studies:
 (i) Elevated ESR with mean ESR 43.42+/-39.68 mm/h.
 (ii) Anti-thyroglobulin antibody in 20%, & anti-TPO antibody in 4% of patients
Recurrence rate:
 (i) NSAID group had recurrence rate of 10.6% in female patients and 12 % in male patients.
 (ii) Steroid group had recurrence rate of 17.5% in female and 10% in male patients.

Nishihara
Et al, 2008 [2]
Tokyo, Japan (1996-2004)N=852 patients (107 M & 745 F) with mean age 47.8±9.4 years (22-83 years).
Presentation:
 (i) Unilateral neck pain in 68.2% of patients.
 (ii) Bilateral neck pain in 31.8% patients.
 (iii) Symptoms of URI in 23% of patients
 (iv) Fever in 28.2%
Recurrence rate 1.6% with interval of recurrence 13.6±5.6 years.

Das, 2012 [5]India
(2010-2012)
N=12 patients (7 M and 5 F) with mean age 51 (range 45-60 years)
Presentation:
 (i) FUO 10/12 patients (83.3%)
 (ii) Neck pain 11/12 patients (91.6%)
 (iii) Localized Erythema and pain 1(8.3%)
 (iv) Raised ESR and CRP in all
 (v) FNAC in 6/12 patients showed multinucleated giant cells.
Treatment:
 (i) Analgesics
 (ii) Beta-blocker
 (iii) Steroids in 8/12 patients (66.6%) for severe symptoms.
Recurrence in 2/12 (16.6%)
Subclinical or overt hypothyroidism at 3 months in 7/12 patients (58.3%) patients.

Alfadda et al, 2014 [3]Riyadh, Saudi Arabia
(2004-2011)
N=25 (5 M and 20 F) with mean age 35.2 (range 3-78 years)
Presentation:
 (i) Palpitation, painful goiter and weight changes were most common symptoms in 40-50% patients
 (ii) Anxiety, nervousness, fatigability and heat intolerance in about 20 % patients
 (iii) Change in appetite, tremors, fever, sweating, mood changes, insomnia and hoarseness of voice in < 20% patients
Long Term Outcome:
 (i) Follow-up period 7± 4 years.
 (ii) Permanent hypothyroidism in 5 (20%) patients.
 (iii) Euthyroid state in 20 (80%) patients.