Subacutegranulomato
A33-year-oldwomanpresentstoherprimarycarephysicianwithneckpain.Thepainbegan2weeksago,isconstantandsharp,andradiatestoherjawandears.Overthepastfewweeks,shehasalsobeenhavingoccasionalloosestoolsandexperiencingfatigue,malaise,andmyalgias.Shehasnohistoryofmedicalproblemsbutdoesreporthavinga“cold”4weeksago.Onexamination,hertemperatureis37.9°C(.2°F),pulse96/min,andbloodpressure/82mmHg.Thereisadiffuseenlargementofthethyroidgland,whichisexquisitelytendertoevenmildpalpation.Relevantlaboratoryresultsinclude:
TSH:1.0μU/mL
Totaltriiodothyronine(T3):ng/dL
Totalthyroxine(T4):20μg/dL
33岁女性，颈部疼痛（2周前开始，持续锐痛，放射到下巴和耳朵）
偶尔有稀烂大便，觉得疲倦、劳累、肌无力
体温较高，体检发现甲状腺弥散性增大（轻轻触碰即引起剧烈疼痛）
1.诊断？
Subacutegranulomatousthyroiditis(SGT=deQuervain’sthyroiditis)=①neckpain(oftenradiatingtothejaw)②exquisitethyroidtenderness③diffusegoiter
病人loosestools,decreasedTSH,elevatedT3andT4为early-stageSGT表现
2.病理生理学？
Viralinfectionofthethyroidglandorapostviralinflammatoryprocess
病人一般会有发病前（颈部疼痛）2-8周有upperrespiratoryinfection
无论诱导SGT的因素是啥，导致的结果都是thyroidinflammationdamagesthyroidfolliclesandreleaselargequantitiesofT4andT3intothecirculation,producingclinicalandbiochemicalhyperthyroidism(onlylastsuntilthereleasedT4andT3aremetabolized)→thyroidfollicularcells的破坏以及高T3和T4水平对TSHrelease的抑制（抑制新的甲状腺素合成）
3.自然病史？
SGT=apredictablecourseofthyroidfunction
病人典型表现为hyperthyroidstatelasting2-8weeks→be
