Subacute Thyroiditis- how long will this last?

[Morey53]

Hello everyone, just looking for advice.

I have been feeling unwell for over 3 weeks- saw GP who listening to my symptoms amd blood tests feels I have subacute thyroiditis.

Very painful left front side of neck, radiating to my ear for a few weeks, now moved to the right side. Feel very jittery!

The bloods on 6th Sept showed:

ESR 100 (range 1-20)

CRP 39.4 (range 0-5)

TSH 0.02 (range 0.27-4.2)

Free T4 36.7 (range 12-22)

Haemoglobin 113

GP has given me Ibuprofen amd Propanolol (as very high heart rate) and ongoing mildly high temp. I have lost about 10lb!

Repeat bloods booked for early Oct and referral to Endocrinology.

Does anyone have any advice on how long this horrible phase lasts for? Just won’t seem to go away!

many thanks!

[greygoose]

Have they tested any antibodies? Ask them to check:

TPO antibodies

Tg antibodies

TRAB

TSI

It might be something other thant subacute thyroiditis.

[Morey53 in reply to greygoose]

Many thanks- the TPO antibodies were tested and it was in normal range (don’t have the figure). As far as I’m aware the others were not tested.

[pennyannie]

Hello Morey and welcome to the forum ;

I'm sorry you are feeling so unwell but hopefully once the pain killers and beta blocker take effect your symptoms will ease.

The Propranolol should reduce your T4 to T3 conversion as it is likely high T3 causing some symptoms and it's unfortunate this further blood test analysis wasn't done.

Do you have any results there for over range and positive antibodies - with symbols/words such as TPO - Thyroid Peroxidase - TgAB - Thyroglobulin - TR ab - Thyroid Receptor - as this would give us a clue as to if you are dealing with a thyroid Auto Immune Disease possible Hashimoto's or Graves - but we can't know which until the antibody blood test comes back.

Both your ESR and CRP - are way over range - showing your body struggling with high inflammation and likely very stressed.

I'm sure your doctor has signed you off from work and early October is just a couple of weeks away - rest up and try not to worry - though I know it's easier said than done

[Morey53 in reply to pennyannie]

Thanks pennyannie. I will try and get the TPO levels.

I’m sure the GP would sign me off but just taken a head of department role- there is never a good time to be sick!!

[pennyannie in reply to Morey53]

No - there isn't and it should not be held against you -

and if you had just employed someone and this happened to them -

I'm sure you would not expect to see them at their best - and support the decision for them to take time out to recover before taking up the new challenge -

This is likely putting additional stress on you - you are not well - not at your best and not in a fit state to do yourself proud.

Your health comes first - I know you know this - it's unfortunate and the timing 'sucks' for want of the better word.

[Habibi87]

Hi Morey53, I started to have subacute thyroiditis exactly a year ago with a bit higher values of CRP and T4 and lower of TSH. The seriously hyper phase lasted about 5 weeks ( heart rate over 150, loosing weight, really hungry but too tired to eat, tremors etc). I took a few extra weeks for my heart rate to get below 100 but it was more manageable at about 115. The pain in my ears, head and thyroid went away almost immediately after been given steroids, but unfortunately it was over two weeks before I was prescribed them and by that point my swollen thyroid was actually visible! For the initial phase I was treated with propanalol and steroids. I then had a few weeks of normal thyroid values and then became hypothyroid and treated with levo (still on it now and only symptom is tiredness). I was pregnant during most of it which probably complicated things a bit. If your pain continues you might want to ask for steroids ?

[Morey53 in reply to Habibi87]

Many thanks for the reply Habibi87. I did wonder about steroids as it has been a few weeks and literally when the ibuprofen starts to wear off after 6-7 hours the pain just comes back, especially at night and wake up with high heart rate.

5 weeks is a long time-that must have been awful. 3 weeks if this is making me feel miserable so can’t imagine what it was like when pregnant!!

[Habibi87 in reply to Morey53]

I was on 20mg prednisolone and felt so much better immediately after the first dose ! Keep in mind that until that point I was only on paracetamol though as ibuprofen is not recommended in pregnancy. Let me know if you need any extra info!

[SlowDragon Administrator]

Essential to test TPO and TG antibodies for autoimmune hypothyroid disease called Hashimoto’s

Hashimoto’s frequently starts with transient hyperthyroid results and symptoms as cells breakdown releasing excess thyroid hormones

It’s not true hyperthyroidism

Test TSI or Trab antibodies for autoimmune hyperthyroidism (grave’s disease)

Also very important to test Vitamin D, folate, ferritin and B12

All thyroid disease often linked to high stress levels

[Morey53]

just an update. Still having a lot of pain and hyperthyroid symptoms so managed to see a consultant yesterday.

New bloods showed

ESR 95 (range 1-20)

TSH <0.01 (range 0.27-4.2)

Free thyroxine 53.6 (range 12-22)

Free T3 14.5 (range 12-22)

Haemoglobin 104

Folate 6.7 (range 8.83- 60.8)

B12 56.0 (range 37.5- 188)

Thyroglobulin Ab 67.9 (range 0-115)

TPO 9.3 (range 0-34)

I have been started on Presnisolone as this has been going on for 5-6 weeks feeling crap so fingers crossed things will improve soon.

I also need to start some iron!

[PurpleNails Administrator in reply to Morey53]

Free thyroxine 53.6 (range 12-22)

Free T3 14.5 (range 12-22)

The FT3 range is same as FT4. FT3 Is Usually much lower, can you check it.

As TPO & TG are negative I would have thought doctor should be testing TSI & or TRAb. You have very high levels. Dr are usually quick t9 start carbimazole antithyroid to lower levels. Do you know why they are still saying thyroiditis and assuming it’s temporary?

[Morey53 in reply to PurpleNails]

Thanks-

The Free T3 is 14.6 (range 3.1- 6.8) sorry!

I am waiting for another antibody test which may take a few weeks apparently.

The consultant thinks it is probably SA thyroiditis due to inflammatory markers and symptoms but it is lasting longer than he would expect. The hyperthyroid symptoms are horrible!

[PurpleNails Administrator in reply to Morey53]

You’d also expect to see high inflammatory markers with Graves. Continuous hyper - Your FT4 has increased significantly. That should start to come down soon or I would ask to start carbimazole to start lowering levels.

Trab antibody test is said to take longer. Seems wrong to make you wait.

[Habibi87 in reply to Morey53]

Hi Morey53, sorry to hear you are still unwell. Hopefully the prednisolone will help. I do think you’d benefit enormously from some rest. I had to stay in bed for a few weeks.Did you have a viral infection (including covid) within a few months of this starting? Subacute thyroiditis seems to often follow a viral infection. Your values now are where mine were when I started the treatment so hopefully they’ll come down. Have you had an ultrasound ? That can also confirm subacute thyroiditis as it has a distinctive appearance. They also wanted to check my antibodies for graves but the hospital didn’t run the test first time around which ended up in more time wasted, so do follow up to ensure they are definitely testing them!

[pennyannie]

Hey there again :

I hope you are signed off work and not feeling guilty :

We tend to answer posts as fully as possible within 24 hours of posting and any new information especially blood test results and ranges deserve a new question/post so we can all easily keep track of your journey rather than find information tacked onto the bottom of what we considered as an ' old and actioned ' reply.

I can't understand why it takes so long to run an antibody blood test to either rule this in or out as being Graves Disease.

Is it a Thyroid Receptor Antibody reading/ range that has been ordered ?

Do you have a ferritin reading there and vitamin D ?

B12 and folate also need supplementing :

I now aim for ferritin at around 100 ; folate 20 ; active B12 75++ and vitamin D around 100;

[Morey53 in reply to pennyannie]

Many thanks- hadn’t realised that it would be better to start a new post.

I’m not sure what Ab test was ordered. I’m assuming it is TRAb .

My ferritin is very high at 294 (range 30-150) probably due to the inflammation and Vitamin D was 104 (range 37.5-188). My Transferrin saturation a few weeks ago was very low at 8% too

[pennyannie in reply to Morey53]

No worries - just for reference next time around - we can always look back if we need to -

Ok - was an iron panel run to get a full breakdown - it's a complex mineral ?

TRab - stands for Thyroid Receptor antibody blood test.

What symptoms are you dealing with ?

[Morey53 in reply to pennyannie]

Main symptoms are pain in my neck radiating to ear, high heart rate around 100-120 resting, lost about 5kg in a few weeks and generally feeling tired.

Iron profile on 31/8/23 showed:

Serum Iron 4 (6-35)

Transferrin 2.08 (2.0-3.6)

Ferritin 155

Transferrin Sat 8%

Ferritin on 25/9/23 was 294

[pennyannie]

I don't know enough in this specialised subject - hopefully having contacted humanbean this lady may be able to help us both better understand :