Background: Patients with thyroid nodules commonly present to clinical attention. The usual evaluation includes a through history and physical examination, laryngoscopy, ultrasonography, and a fine-needle aspiration cytology (FNAC) when there is a suspicion of malignancy. This case report highlights the entity of pseudo-nodules that can resolve spontaneously with conservative management. Case Description: A 58-year-old Chinese female in Singapore presented with an episode of left anterior neck pain and swelling that started spontaneously and lasted a month. Thyroid function tests showed subclinical hyperthyroidism without antibodies against thyroglobulin, thyroid peroxidase, and thyrotropin receptor. Ultrasonography of the neck showed two right-sided thyroid nodules (2.5 and 1.1 cm) with intermediate risk of malignancy. Thyroid scintigraphy revealed overall reduced tracer uptake with photopenia of the right mid-to-lower pole. She was diagnosed with subacute thyroiditis and managed conservatively with non-steroidal anti-inflammatory drugs (NSAIDs). During subsequent reviews, her thyroid nodules nearly completely resolved 9 months later and her thyroid function normalized. Conclusions: Our patient's clinical course, imaging, and laboratory work-up supports a diagnosis of De Quervain's thyroiditis. Inflammatory pseudonodules can be found in this condition and are known to resolve spontaneously. Except for marked hypoechogenicity, the pseudonodules do not display other suspicious features on ultrasonography. As thyroid nodules are increasingly diagnosed, it is timely to remember the entity of inflammatory pseudonodules which can spontaneously resolve. Clinicians should recognize this diagnosis to avoid performing unnecessary FNAC or generating excessive concerns about cancer in their patients.
Background: Thyroid nodules are encountered in 19–68% of the population and in most cases require observation due to the risk of malignancy. Spontaneous intrathyroidal hemorrhage is a rare phenomenon that occurs in case of trauma or ulceration of a large vessel. The management of this patient group depends, first of all, on the severity of bleeding and airway obstruction. In order to assess the degree of compression provided by surrounding tissues, the most optimal method is ultrasonography. Decompression can be performed by ultrasound-guided puncture or drain placement in case of fluid collection. In most cases, bleeding stops with the use of conventional therapy. In case of dyspnea, an increase in the neck size and volume of hematoma, hemodynamic instability, an emergency intubation and surgical intervention is indicated.
Thyroid-stimulating hormone (TSH) is commonly ordered in the investigation of delirium as thyroid dysfunction is a known cause of delirium. Previous studies have recommended against the routine testing of thyroid function in all in-patients due to low clinical yield and excess use of resources. This has not been investigated in in-patients admitted for delirium specifically. We aimed to investigate the clinical yield of thyroid function testing in in-patients admitted for delirium.
