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.