Sandbox:DDx HEENT

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  • 30-50 yo women, self limited
  • Subacute onset
  • Painful neck swelling with fever, malaise, and fatigue
  • Symptoms of thyrotoxicosis followed by transient hypothyroid symptoms
  • Tender mid-line neck swelling


  • Initial increase in T3 and T4 with decreased TSH
  • Followed by decrease in T3 and T4 with increased TSH
  • Return to normal baseline thyroid function
  • Poorly defined hypechogenic region on U/S
  • Decreased vascularity in the affected areas
  • Low uptake thyroid iodine scan
  • Accumulation of neutrophils with follicular destruction and colloid depletion
  • Noncaseating granulomas formation
  • Fibrosis may develop
  • HLA-B35
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