A Case of Retropharyngeal Soft-Tissue Swelling: The Definitive Diagnosis Revealed

To the Editor.— In a recent issue, a patient with neck tenderness, fever, and retropharyngeal swelling was described.1The diagnosis of subacute thyroiditis was made on the basis of an increased erythrocyte sedimentation rate, thyroid tenderness, and a markedly depressed thyroid uptake of radioiodine. Treatment with antibiotics and corticosteroids resulted in resolution of the symptoms. The authors made a diagnosis of subacute thyroiditis. Such a conclusion is not supported by the information given. Infectious thyroiditis not uncommonly results in a decreased thyroid radioiodine uptake.2Because the patient received antibiotics (although for only two days), infectious thyroiditis remains a possibility. A negative result on examination of a fine-needle aspirate is not sufficient to rule out infectious thyroiditis. Fine-needle aspiration of the thyroid can provide a definitive diagnosis of subacute thyroiditis,3and only if cytologic or histologic evidence of subacute thyroiditis is obtained can the authors' claim be accepted.