title: Subacute thyroiditis manifesting as a thyroid mass, vocal cord paralysis, and hypercalcemia.
abstract: OBJECTIVE
  To report a case of subacute thyroiditis manifesting as a thyroid mass, vocal cord paralysis, and hypercalcemia.
  
  
  METHODS
  We describe the clinical, laboratory, and radiologic findings in a patient with an unusual clinical course of subacute thyroiditis.
  
  
  RESULTS
  A 65-year-old woman presented with a hoarse voice and an enlarging tender mass in the right side of the neck. On admission, thyroid function was consistent with thyrotoxicosis from subacute thyroiditis. Laboratory studies showed a corrected serum calcium concentration of 11.4 mg/dL, intact parathyroid hormone of 125 pg/mL, 25-hydroxyvitamin D of 12 ng/mL, and creatinine of 1.8 mg/dL. Computed tomography of the neck without use of a contrast agent showed a heterogeneous mass in the right side of the neck in conjunction with deviation of the trachea from right to left but without invasion of the trachea. Thyroid ultrasonography disclosed a heterogeneous mass in the right thyroid lobe measuring 4.7 cm by 5.5 cm by 4.5 cm. Flexible laryngoscopy revealed right vocal cord paralysis. Treatment with a course of prednisone yielded normalization of the serum calcium level, improvement in her voice, and a decrease in size of the thyroid mass. Four months after initial presentation of the patient, thyroid hormone levels became normal, she was clinically euthyroid, and she had a full recovery of her voice. Her serum calcium concentration was normal (9.8 mg/dL) in association with a near-normal parathyroid hormone level of 90 pg/mL. The 25-hydroxyvitamin D and creatinine values were also normal. Repeated thyroid ultrasonography showed a smaller right thyroid lobe with a dominant nodule measuring 2.0 cm by 1.3 cm by 1.4 cm in the right upper pole.
  
  
  CONCLUSIONS
  This case illustrates that subacute thyroiditis can have the unusual initial manifestations of a thyroid mass, vocal cord paralysis, and hypercalcemia. In similar patients, a trial of corticosteroid therapy may be warranted in an effort to improve clinical symptoms and thus avoid unnecessary surgical treatment.
authors.affiliation: Division of Endocrinology, Metabolism and Nutrition, Department of Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, New Jersey 08903-0019, USA. Cindy.Huang@gmail.com
authors.forename: Cindy
authors.initials: C
authors.lastname: Huang
authors.forename: Xiangbing
authors.initials: X
authors.lastname: Wang
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D005260:Female; D006685:Hoarseness / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology* / Q000517:prevention & control; D011241:Prednisone / Q000627:therapeutic use; D016606:Thyroid Nodule / Q000209:etiology* / Q000517:prevention & control; D013968:Thyroiditis, Subacute / Q000188:drug therapy / Q000503:physiopathology*; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology* / Q000517:prevention & control
chemical_list: D000893:Anti-Inflammatory Agents; D011241:Prednisone