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January 1981

Graves' Disease After Thyroiditis

Arch Intern Med. 1981;141(1):139. doi:10.1001/archinte.1981.00340010131031

To the Editor  —The report by Werner in the November Archives (1980; 139:1313-1315) concerning Graves' disease after subacute thyroiditis points out the utility of needle aspiration or biopsy in assessing thyroid disease.1 The eminent author rejected hemorrhage into an adenoma as the diagnosis. The data, including normal ESR, normal uptake, normal thyroxine and triiodothyronine values, cold area on scan, and negative antibodies, all favor hemorrhage into an adenoma over subacute thyroiditis. In numerous similar cases seen at the Cleveland Clinic, needle aspiration has confirmed a diagnosis of hemorrhage into an adenoma.Since the diagnosis is not clearly established by the data, needle biopsy or aspiration would have been helpful.In most patients with pain, aspiration of hemorrhagic contents results in prompt relief of pain. After aspiration of 5 to 20 mL of blood, the remaining palpable tissue may be small. Thus, Dr Werner's argument that a rim of tissue

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