A 35-year-old woman presents with acute onset severe thyroid pain, fever, and malaise following an upper respiratory tract infection. Laboratory investigations show elevated ESR, normal thyroid function tests, and a low radioiodine uptake on thyroid scan. What is the drug of choice for this condition?

Question

Accepted Answer

B. Aspirin. ## Diagnosis: Acute Viral (De Quervain's) Thyroiditis

This clinical presentation is classic for acute viral thyroiditis (also called subacute or de Quervain's thyroiditis):
- Severe thyroid pain and tenderness
- Fever and systemic symptoms
- Preceding viral URI
- Low radioiodine uptake (distinguishes from Graves' disease)
- Elevated inflammatory markers (ESR)

## Drug of Choice: NSAIDs (Aspirin)

**Key Point:** NSAIDs are first-line therapy for acute viral thyroiditis because they address both pain and inflammation.

**High-Yield:** The treatment algorithm for acute thyroiditis:

| Severity | First-Line | Second-Line | Third-Line |
|----------|-----------|------------|------------|
| Mild-moderate | NSAIDs (Aspirin, Ibuprofen) | — | — |
| Moderate-severe | NSAIDs + Beta-blocker (for symptom relief) | Corticosteroids (if NSAID failure) | — |
| Severe/refractory | Corticosteroids (Prednisolone 20-40 mg/day) | — | — |

**Clinical Pearl:** Aspirin and other NSAIDs provide:
1. Anti-inflammatory effect (reduces thyroid inflammation)
2. Analgesic effect (relieves severe thyroid pain)
3. Antipyretic effect (controls fever)

**Tip:** Beta-blockers (like propranolol) may be added for symptomatic relief of tachycardia and palpitations caused by thyroid hormone release, but they are NOT first-line and do not treat the underlying inflammation.

## Why Other Options Are Incorrect

- **Propranolol:** Addresses sympathetic symptoms (tachycardia, tremor) but does NOT treat inflammation or pain — it is adjunctive, not primary therapy.
- **Levothyroxine:** Indicated only if hypothyroidism develops in the recovery phase; not used in acute phase.
- **Propylthiouracil:** Used for Graves' disease (high uptake thyroiditis), not viral thyroiditis (low uptake).

Answer

A. Levothyroxine

Answer

C. Propylthiouracil

Answer

D. Propranolol

Explanation

Diagnosis: Acute Viral (De Quervain's) Thyroiditis

Drug of Choice: NSAIDs (Aspirin)

Why Other Options Are Incorrect

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Severity	First-Line	Second-Line	Third-Line
Mild-moderate	NSAIDs (Aspirin, Ibuprofen)	—	—
Moderate-severe	NSAIDs + Beta-blocker (for symptom relief)	Corticosteroids (if NSAID failure)	—
Severe/refractory	Corticosteroids (Prednisolone 20-40 mg/day)	—	—