## 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).
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