Pyrexia of unknown origin (PUO) poses a great diagnostic challenge to the clinicians and could be caused by infection, inflammation, neoplasm or other miscellaneous conditions. Subacute thyroiditis (SAT) is an inflammatory, self-limiting condition and is a very rare cause of PUO. Usually, it presents with anterior neck pain, tender goiter, and rarely with cervical lymphadenopathy. Clinical features of thyrotoxicosis may not be overt. This condition has viral etiology. Painless SAT is rare and can present as PUO. We present a rare case of SAT in a middle-aged male without any neck pain or thyromegaly. Investigations showed low TSH, elevated T3 and T4, raised ESR and CRP. Thyroid antibodies were negative. USG findings were typical of SAT. Tc99 scan showed poor or no uptake. Patient was treated with NSAIDs, oral steroids and beta blockers. He eventually developed hypothyroidism and is on thyroid supplement. We aim to highlight that painless SAT can be a cause of unexplained fever and clinician should keep this possibility in mind even in absence of clinical features of thyrotoxicosis.
Key words: PUO, Radioisotope scan, Subacute thyroiditis, Thyroid dysfunction, Thyroid function test, Ultrasonography
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