—Dr Sheeler, in his letter above, apparently has concluded that the patient described in my case report had a hemorrhage into a nontoxic nodule rather than acute (subacute) thyroiditis, before the development of Graves' disease. He suggests that aspiration biopsy with a coarse needle (Crile) might have resolved the issue and relieved the patient's pain. As evidence, he cites the normal ESR and tests of thyroid function, as well as the 1.5-cm, cold area on scan.
The scan, however, was performed at the beginning of the present illness, whereas the blood tests were conducted two weeks later, during her first visit to the Columbia Presbyterian Medical Center (CPMC). During that interval, she had been given prednisone by her physician, with striking relief of pain, an immediate recurrence when medication was discontinued for a day, and renewed relief with reestablishment of treatment. This sequence of events seems to me much more