We describe an atypical case of subacute thyroiditis affecting a 50 year old patient with long lasting fever, weight loss, malaise and a high erythrocyte sedimentation rate. Cytological examination of the thyroid gland showed the classic granulomas with giant cells. However, the patient had neither painful enlargement of the gland nor thyrotoxicosis. This case, as well as others previously described, probably represents a new subtype of subacute thyroiditis, painless giant cell thyroiditis. The presence of painless giant cell thyroiditis should be considered in any patient with undiagnosed pyrexia, weight loss and elevated ESR.
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