HI YOU ARE A PATIENT OF SUBACUTE THYROIDITIS. The onset may be sudden or gradual and may be preceded by an upper respiratory infection. The pain may be limited to the region of the thyroid or radiate to the upper neck, jaw, throat, upper chest, or ears. Pain can be exacerbated by coughing or turning the head. Fever, fatigue, malaise, anorexia, and myalgia are common . The thyroid gland is typically slightly or moderately diffusely or asymmetrically enlarged, and nearly always tender. In some cases, the pain is so severe that the patient cannot tolerate palpation of the neck. Both thyroid lobes are involved from the beginning in most patients, but the pain, tenderness, and enlargement can be unilateral or start on one side and later spread to the other side days or even weeks (so called “creeping thyroiditis”) later . Approximately one-half of patients have symptoms and signs of hyperthyroidism, but the neck pain and tenderness usually dominate the illness, and the diagnosis should not routinely be made in their absence. Temperature elevations also can occur . The thyroid inflammation and hyperthyroidism are transient, usually subsiding in two to eight weeks, even if the patient is not treated. It may be followed by a period of transient, usually asymptomatic hypothyroidism lasting from two to eight weeks or longer, but recovery is nearly always complete. In the majority of patientS are treated with either a nonsteroidal antiinflammatory drug or prednisone is indicated . A reasonable approach is to start with acetylsalicylic acid (aspirin, 2600 mg daily) or a nonsteroidal antiinflammatory drug (eg, ibuprofen 1200 to 3200 mg daily) in divided doses. If there is no improvement in two or three days, the nonsteroidal antiinflammatory drug should be discontinued and prednisone (40 mg daily) initiated. Prednisone therapy should result in pain relief in one to two days; if not, the diagnosis should be questioned. In patients with severe pain, prednisone is a reasonable first-line therapy. TAKE CARE