Unilateral pharyngalgia as the dominant symptom in subacute thyroiditis: Case series and analysis of diagnostic pitfalls in clinical practice

Subacute thyroiditis is a condition with varied and often misleading symptoms, which can lead to diagnostic delays and inappropriate treatment. This case series focuses on 32 patients who presented with unilateral pharyngalgia as the primary symptom and were ultimately diagnosed with subacute thyroiditis. The patients, aged 28-52 years with a female predominance (23 females and nine males), reported pharyngeal pain that lasted from 7 days to 3 months, with 19 having left-sided and 13 having right-sided initial pain. Of these patients, 43.7% (14/32) were initially misdiagnosed, primarily as pharyngitis or tonsillitis. Key diagnostic findings included thyroid tenderness, abnormal thyroid function, elevated erythrocyte sedimentation rate, characteristic manifestations on thyroid ultrasound, and decreased radioactive iodine uptake. Treatment varied by pain severity. In conclusion, unilateral pharyngalgia is frequently mistaken as other common throat conditions. Thyroid palpation should be routine in patients with unilateral pharyngalgia; positive findings warrant further tests (C-reactive protein, ultrasound, radioactive iodine uptake) to confirm subacute thyroiditis.