Endocrine and Metabolicmiddle twist
A 38-year-old woman presents with three weeks of aching pain in the front of her neck that worsens when she turns her head or swallows and radiates up to both ears. It followed a flu-like illness. She has lost 2 kg, feels hot and shaky, and her heart races. Her temperature is 37.9 °C, pulse 108/min, and the thyroid is firm and exquisitely tender. Results: free T4 34 pmol/L (10–20), TSH < 0.01 mU/L (0.4–4.0), erythrocyte sedimentation rate 82 mm/h (<20), thyroid peroxidase antibody negative, TSH-receptor antibody negative. A technetium thyroid scan shows negligible tracer uptake.
Which one of the following is the most appropriate management?