Sometimes, a viral infection can have baffling side effects and trigger conditions that aren’t easy to detect. It is important for us to watch tell-tale signs if any and not ignore them. Or the patient could end up spending money on a battery of tests for other conditions to no avail. Just a few weeks ago, I had one such case, a 55-year-old woman with subacute thyroiditis, a temporary inflammation of the thyroid gland brought on by a viral infection she had had a few weeks ago and had recovered from. Although she had recovered from her viral fever, she continued to have some throat and neck pain, difficulty swallowing and periodic bouts of both high grade and low grade fever for about a month-and-a-half. She went from doctor to doctor and underwent blood marker tests, autoimmune disorder tests, even those for typhoid, dengue and malaria. All turned out negative. Imaging scans like chest X-rays, ultrasound and CT scan, usually done to check for blocked sinuses or pneumonia-induced congestion, came out clean. Her echocardiogram and electrocardiogram to check for heart status turned out to be normal. Even her levels of C-reactive protein (CRP), which is a measure of inflammation or infection in the body, though higher than the usual 1.0 mg/dL, were not that alarming. Then her ENT prescribed something for symptomatic relief, her regular doctor put her on another cycle of medication. When she came to me with all her reports, I noticed a few things. She repeatedly complained of pain in her neck, jaw or ears, difficulty swallowing, hoarseness and a never-ending fatigue. I suspected some inflammation in the thyroid gland although her thyroid tests were normal and pressed them. She winced. She told me that she had suffered some weight loss because she had not been eating properly because of the throat pain and the bouts of fever. She also told me that she was sweating more than usual and that she was experiencing hand tremors. And that these changes happened after her viral fever. She was displaying classic signs of subacute thyroiditis, when the thyroid gland gets inflamed and may release too much thyroid hormones, a condition called hyperthyroidism. Very rarely, the virus can also push down thyroid hormone levels, triggering hypothyroidism. The problem with this condition is that a thyroid test done during the period of viral infection or immediately after it may not show the increased levels. The damage caused by the virus may take time to show up. That’s why I repeated it and the results confirmed my suspicion. Subacute thyroiditis can leave your thyroid painful and swollen for weeks or, in rare cases, between three to six months. Initially, I put her on the simple anti-inflammatory medication, Ibuprofen, and a beta blocker to settle her heart rate, which tends to race under such conditions, and rein in her overactive thyroid. As her inflammation subsided, her thyroid levels went down as did her CRP levels. She even regained her strength. Usually, a simple thyroid profile test (TSH, T3 and T4), when you do experience such conditions after a viral fever, is good enough for diagnosis. A thyroid scan is just a confirmatory test. This case was a lesson how the recovery from a viral infection needs to be watched just as carefully. (Dr Tickoo is Director, Internal Medicine, Max Superspeciality Hospital, Delhi)
