Rule out Thyroid Disease

Naturally, causes of sore throat mostly fall into the field of ENT specialists. However, thyroid disease, such as subacute granulomatous thyroiditis (De Quervain‘s thyroiditis), should also be considered. It is often preceded by a (viral) upper respiratory tract infection and characterized by intense tenderness of the neck. Other findings indicative of subacute thyroiditis include leukocytosis, markedly elevated erythrocyte sedimentation rate (ESR), fatigue, and significantly heterogeneous echotexture on ultrasound. In addition, technetium-99m scintigraphy shows reduced to missing activity uptake. Since treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) alone is often inadequate, corticosteroids must be used; however, (rare) bacterial thyroiditis should first be ruled out. In patient with recurrent disease and elderly patients, radioactive iodine therapy should be considered as the treatment of last choice; however, in this case, radioiodine uptake must first be restored by cortisone treatment.