Horm Metab Res 2020; 52(01): 32-38
DOI: 10.1055/a-1033-7524
Endocrine Care
© Georg Thieme Verlag KG Stuttgart · New York

Time-Lag Between Symptom Onset and Diagnosis of Subacute Thyroiditis – How to Avoid the Delay of Diagnosis and Unnecessary Overuse of Antibiotics

Magdalena Stasiak
1  Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
,
Renata Michalak
1  Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
,
Bartłomiej Stasiak
2  Institute of Information Technology, Lodz University of Technology, Lodz, Poland
,
Andrzej Lewiński
1  Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
3  Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
› Author Affiliations
Further Information

Publication History

received 31 July 2019

accepted 15 October 2019

Publication Date:
26 November 2019 (online)

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.