MON-341 - Subacute Thyroiditis Like A Manifestation of the Expanded Dengue Syndrome

Subacute Thyroiditis is characterized by neck pain or discomfort, a tender diffuse goiter, and a predictable course of thyroid function evolution. Hyperthyroidism is typically the presentation followed by euthyroidism, hypothyroidism, and ultimately restoration of normal
thyroid function. The Expanded Dengue Syndrome encompasses a broad spectrum of uncommon presentations of Dengue, including gastrointestinal, hepatic, neurological, pulmonary and renal involvement. Thyroid involvement, in the form of Subacute Thyroiditis is an extremely rare manifestation within this syndrome.
We report a case of a 13 years old girl with fever, myalgias, arthralgias, headache, retro-orbital pain, rigors, chills and vomiting. On 8th. day of illness she developed sore throat and painful swelling in front of neck accompanied by high grade fever, dysphagia, hoarseness of voice, palpitations and tremors. Physical examination was remarkable for tachycardia, fever, fine tremors and thyroid swelling. Thyroid was swollen, warm and tender and patient had painful deglutition. Anti-Dengue IgM by ELISA was positive. Ultrasonography of neck revealed diffuse heterogeneity and low intensity vascular flow in the thyroid area. Thyroid function tests showed high free T3 and T4, and low TSH. Erythrocyte sedimentation rate was 73 mm in 1st. hour. On Technetium scanning of the thyroid, the thyroid gland was not visualized due to poor tracer uptake. The patient received 50 mg daily dose of oral prednisone and pain improved in three days. Dose was subsequently reduced to 10 mg daily and was tapered off in six weeks. Oral propranolol was given for relief of symptoms related to hyperthyroidism during the first week. At one month the thyroid was palpated (goiter grade Ib) with irregular surface, not painful to palpation and without tremor. At 2 months, the patient was asymptomatic without corticosteroids and had normal free T3, T4, TSH and thyroglobulin levels.
It is important identifying atypical manifestations of Dengue, such as Subacute Thyroiditis, which is rare and its diagnosis requires a high degree of suspicion, taking into account the clinical (patients with Dengue fever who develop painful thyroid swelling and clinical features of hyperthyroidism), epidemiological history, laboratory, ultrasound and thyroid scintigraphy.

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