Abstract
Clinical symptoms of subacute thyroiditis (SAT) may be misleading and the proper diagnosis
is significantly delayed, and many unnecessary therapeutic methods are used, including
application of antibiotics. The purpose of the study is to analyze the reasons and
frequency of delayed SAT diagnosis and unnecessary antibiotic treatment and to propose
a simple algorithm to facilitate the diagnosis and prevent antibiotic abuse. Sixty-four
SAT patients were divided into groups depending on the period of time from the first
symptoms of SAT to diagnosis and on the unnecessary use of antibiotics. Data from
medical history and laboratory test results were analyzed for individual groups to
determine the reasons for delayed diagnosis and incorrect treatment. In 73% of patients,
the diagnosis was delayed from over two weeks up to six months. Among 62 patients
who provided data on antibiotic use, 29 (46.77%) were treated with one or more antibiotics
due to SAT symptoms. Fever, preceding infection, increased C-reactive protein (CRP),
and WBC were characteristic for the antibiotic treated group. Fever, preceding infection,
increased CRP and WBC are typical for both SAT and infection and are the main symptoms
leading to misdiagnosis and unnecessary antibiotic treatment in SAT. Thus, in all
patients with neck pain or other SAT-like symptoms, thorough clinical examination
of the neck is mandatory. When firm and/or tender thyroid nodule/goitre is present
and erythrocyte sedimentation rate /CRP is increased, patient should be promptly referred
to an endocrinologist, and antibiotics are not recommended.
Keywords
subacute thyroiditis - late diagnosis - antibiotic abuse - infection
