Weiss B M, Hepburn M J, Mong D P
Department of Medicine, Brooke Army Medical Center, Fort Sam Houston, Tex 78234-6200, USA.
South Med J. 2000 Sep;93(9):926-9.
Subacute thyroiditis (SAT) usually occurs in women in middle age with a viral prodrome, thyroid or neck tenderness, classic symptoms of thyrotoxicosis, and elevated erythrocyte sedimentation rate (ESR). We report a case in an 81-year-old man who initially had 2 days of fever to 101.2 degrees F, confusion, and bilateral lower extremity weakness. Extensive evaluation was remarkable only for the following laboratory values: thyrotropin (TSH) 0.02 microIU/mL, free thyroxine (FT4) 3.1 ng/dL, free triiodothyronine (FT3) 6.0 pg/mL, and ESR 98 mm/hr. One week later, the patient had persistent fevers to 102 degrees F; no source was found. The fever resolved, and 3 months later the patient had profound hypothyroidism (TSH >44.0 microIU/mL, FT4 0.4 ng/dL, ESR 13 mm/hr). A painless thyroid gland and atypical manifestations of hyperthyroidism are unusual in SAT. When fever is of unknown origin, SAT should be considered even if classic features are absent.
亚急性甲状腺炎（SAT）通常发生于中年女性，伴有病毒前驱症状、甲状腺或颈部压痛、典型的甲状腺毒症症状以及红细胞沉降率（ESR）升高。我们报告一例81岁男性病例，该患者最初发热2天，体温达101.2华氏度，伴有意识模糊和双侧下肢无力。全面评估仅发现以下实验室检查值异常：促甲状腺激素（TSH）0.02微国际单位/毫升，游离甲状腺素（FT4）3.1纳克/分升，游离三碘甲状腺原氨酸（FT3）6.0皮克/毫升，ESR 98毫米/小时。一周后，患者持续发热至102华氏度；未发现病因。发热消退，3个月后患者出现严重甲状腺功能减退（TSH>44.0微国际单位/毫升，FT4 0.4纳克/分升，ESR 13毫米/小时）。无痛性甲状腺以及甲状腺功能亢进的非典型表现在亚急性甲状腺炎中并不常见。当发热原因不明时，即使没有典型特征，也应考虑亚急性甲状腺炎。
