USMLE (United States Medical Licensing Examination) Step 1 Practice Exam

Which condition presents with a tender gland, fever, and bacterial infection, but with decreased 123-I uptake?

1. Acute thyroiditis

2. Hashimoto thyroiditis

3. Pituitary apoplexy

4. Subacute granulomatous thyroiditis

The correct answer is: Acute thyroiditis

The condition characterized by a tender gland, fever, and bacterial infection, alongside decreased uptake of 123-I, is acute thyroiditis. This condition often results from a bacterial infection, leading to inflammation of the thyroid gland. The presence of fever and tenderness associated with the gland indicates an acute inflammatory process, commonly linked to an infectious etiology. In acute thyroiditis, the inflammatory process can cause damage to the thyroid tissue, which impairs the gland's ability to absorb iodine, as measured by the 123-I uptake test. Therefore, a decreased level of uptake reflects the dysfunction of the thyroid gland due to the acute inflammatory response. Other conditions, such as Hashimoto thyroiditis and pituitary apoplexy, do not typically present with acute fever and tenderness of the thyroid gland. Hashimoto thyroiditis is more chronic in nature and usually does not involve significant acute tenderness or fever but is characterized by autoimmunity leading to thyroid tissue destruction. Pituitary apoplexy occurs in the pituitary gland and is associated with symptoms such as headaches and visual disturbances, rather than tenderness or fever in the thyroid. Subacute granulomatous thyroiditis, while it can present with tenderness and fever, is typically associated with viral infection and would not usually show decreased iodine