Two Important Issues in Subacute Thyroiditis Management: Delayed Diagnosis and Inappropriate Use of Antibiotics

Abstract

Background: Subacute thyroiditis (SAT) is a rare inflammatory disease of the thyroid gland. It has been noticed that patients with a diagnosis of SAT visit more other clinics and receive antibiotics unnecessarily. Therefore, the aim of this study was to reveal the degree of delay in the diagnosis of SAT, prediagnosis antibiotic use rates, and the awareness of clinics for the diagnosis of SAT. Methods: A total of 121 patients with SAT were enrolled in the study. A retrospective analysis was made of the history of patient symptoms during the diagnosis, which physicians they visited, antibiotic use, laboratory test results, and ultrasonographic findings. Results: The median age of the patients was 41 years. Neck pain radiating to the jaw/ear was seen in most patients (71.1%). The median time from symptom onset to a diagnosis of SAT was 23 days (range, 6–70 days). Antibiotics were erroneously prescribed to 71 patients (58.7%) before the diagnosis. The median time to diagnosis was 28 days in patients using antibiotics and 20 days in the group not using antibiotics (p < 0.001). Two or more physicians had been visited before SAT diagnosis by 89 (73.6%) patients, and more antibiotics were prescribed to these patients than the group who visited fewer physicians (p < 0.05). The frequency of prescribing antibiotics by physicians was 73.7% by emergency physicians, 53.1% by family doctors, 51.1% by ENT specialists, and 35.4% by internal medicine specialists. Conclusion: The diagnosis of SAT is often delayed, and misdiagnosis leads to erroneous antibiotic overuse. Physicians should increase their awareness of the diagnosis of SAT in patients with neck pain.

Clinical characteristics of patients with subacute thyroidits and factors affecting development hypothyroidism after subacute thyroiditis

“…Few studies have focused on delayed diagnosis of SAT. Stasiak and colleagues found that the prediagnosis period was prolonged up to 70 days (17), and Bostan and colleagues (18) found a mean time to diagnosis of 23 days (range, 6-70 days), similar to our findings. In Görges and colleagues' study, the time to diagnosis ranged from 2 days to 1 year (7).…”

“…In our study, the time to a correct diagnosis was significantly longer in such patients compared with patients not prescribed antibiotics. Similar findings were noted in the Bostan study (18). However, Stasiak and colleagues did not find any difference in time to diagnosis by antibiotic use (17).…”

“…In Görges and colleagues' study, the time to diagnosis ranged from 2 days to 1 year (7). In Bostan's study, 73.6% of patients were admitted to other specialties before receiving the correct diagnosis (18), a larger proportion than the 57.1% of our patients who saw other specialists first, but their distribution of specialties was similar to ours (internal medicine, otolaryngology, emergency departments, and infectious disease) (18). The percentages of radiating pain and fever were also similar between Bostan's study and ours (71% vs. 68% for radiating pain, respectively, and 46% in both studies for fever).…”

“…Thirty-four (28.6%) of our patients, 58.7% of Bostan's patients, (18) and 46.7% of Stasiak's patients (17) had been prescribed antibiotics erroneously. In our study, the time to a correct diagnosis was significantly longer in such patients compared with patients not prescribed antibiotics.…”

Two cases of subacute thyroiditis after different types of SARS-CoV-2 vaccination

“…Post COVID-19-vaccination SAT Arch Endocrinol Metab. (28,29). In both cases presented in this paper, SAT could not be detected at the first examination and antibiotics were recommended to the patients, but case 2 did not use antibiotics.…”