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Medical Resident Research Case Reports

23 TIDES OF THE THYROID II: THYROTOXICOSIS FROM SUBACUTE THYROIDITIS

Waivelle Farmer, MD; Eric O'Neal, MD; Emil Montano, DO; Pavitra Balasubramanian, MD; Kimberly Bird, MD Corresponding author: Waivelle.Farmer@LPNT.net

Sovah Health - Danville, Danville, Virginia

above, along with an extrathyroidal anterior neck mass of 2.9 cm x 1.8 cm. mentioned. Her propranolol was uptitrated to 40 mg by mouth daily, which was critical for the improvement of her symptoms. The patient was discharged home with a 5-day course of Cefdinir for her acute cystitis. Comments: The etiology of the patient’s thyrotoxicosis was illustrated through subacute thyroiditis, which is usually preceded by a viral infection. Females are more commonly affected, with an average age of 35 years old. This phenomenon follows a 3-phase course: symptomatic thyrotoxicosis, painless thyrotoxicosis, and euthyroidism. The most common symptoms include neck pain, palpitations, and weight loss. Imaging will likely reveal low uptake with radioactive iodine and low vascularity. The key for treatment is to minimize symptoms, which include using beta-blockers and corticosteroid therapy. Short tapering to corticosteroids have demonstrated better outcomes for this phenomenon. Due to patient’s physical deconditioning during her hospital stay, patient was

discharged to a skilled nursing facility and had close follow-up with Endocrinology, including repeating thyroid functions within 4-6 weeks. Thyrotoxicosis is a dangerous, symptomatic condition associated with hyperthyroidism that can serve as a precursor to thyroid storm. Prompt identification is critical for immediate treatment, including supportive care and involving a multidisciplinary team. Diagnosis: Hyperthyroidism, in the setting of Thyrotoxicosis Reference: [1] Majed, Z., Janji, M., Basma, H., Paola, P. Thyrotoxicosis: Unraveling the Mystery of Fever. Cureus 2025 Jun;17(6); e85747.

Context: Thyrotoxicosis encompasses all conditions with elevated thyroid hormones, causing a variety of adrenergic symptoms secondary to amplified catecholamine signaling. Graves' Disease is the most common cause of hyperthyroidism, followed by multinodular goiter. This phenomenon can serve as a precursor to thyroid storm, known to be a medical emergency. Report of Case: We present a 76-year-old female with a past medical history of a multinodular goiter who initially presented to the hospital for generalized weakness, anorexia, weight loss, and diffuse tremors. The patient was previously treated for a Clostridium difficile infection prior to admission. Previous records revealed the following: a fine needle-aspiration on 12/18/2024 revealed atypia of undetermined significance, and a thyroid ultrasound on 11/13/2024 revealed a multinodular goiter, TI-RADS 2 and TI RADS 3, respectively. Lab findings and symptoms were consistent with thyrotoxicosis and acute simple cystitis. CT Head and Neck revealed findings mentioned

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154 Edward Via College of Osteopathic Medicine (VCOM)