Differential Diagnosis

The patient presents with neck swelling, palpitations, heat intolerance, and increased sweating, which are suggestive of a thyroid disorder. The following differential diagnoses are considered:

• Single Most Likely Diagnosis

  • Thyroiditis (De Quervain's thyroiditis): The patient's symptoms of neck swelling, pain, and odynophagia, along with a recent history of viral infection, support this diagnosis. The absence of weight loss, tremors, and exophthalmos also points towards thyroiditis.

• Other Likely Diagnoses

  • Subacute Thyroiditis: This condition can present with neck pain, swelling, and symptoms of hyperthyroidism, similar to De Quervain’s thyroiditis. The distinction often relies on the specific characteristics of the thyroid pain and the phase of the illness.
  • Graves' disease: Although the patient has no exophthalmos, lid retraction, or tremors, the presence of tachycardia and heat intolerance cannot be ignored. Family history of Graves' disease also increases the likelihood of this diagnosis.
  • Toxic Multinodular Goiter: The patient's thyroid gland is enlarged and symmetrically palpable, which could be consistent with a toxic multinodular goiter. However, the absence of a palpable thrill or audible bruit makes this diagnosis less likely.

• Do Not Miss

  • Thyroid Storm: Although the patient's symptoms are not severe enough to suggest a thyroid storm, it is essential to consider this diagnosis due to its high mortality rate. The presence of tachycardia, heat intolerance, and increased sweating could be indicative of a thyroid storm.
  • Mediastinal Mass: Although less likely, a mediastinal mass could cause neck swelling and compression symptoms, and it is crucial to rule out this diagnosis due to its potential severity.

• Rare Diagnoses

  • Thyroid Cancer: Although rare, thyroid cancer could present with neck swelling and thyroid gland enlargement. However, the absence of other symptoms such as weight loss, hoarseness, or difficulty swallowing makes this diagnosis less likely.
  • Riedel's Thyroiditis: A rare form of thyroiditis characterized by a hard, fibrotic thyroid gland, which could cause neck swelling and compression symptoms. However, the patient's symptoms and examination findings do not strongly support this diagnosis.