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Abstract
Painful Hashimoto's thyroiditis (HT) is a subtype of HT characterized by thyroid pain with overt elevation in inflammatory markers and thyroid autoantibodies. The differential diagnosis of painful HT with subacute granulomatous thyroiditis is often difficult because initial clinical findings are very similar. Findings that favor the diagnosis of painful HT include preceding history of chronic goiter or autoimmune thyroid diseases, a high titer of thyroid autoantibodies, and repeated painful attacks even with chronic glucocorticoid therapy. Surgery is often needed to relieve the thyroid pain.
We report a case of painful HT who received only temporary relief from steroid therapy and required total thyroidectomy for relapsing thyroid pain. The clinical responses to steroid and surgical therapy are described, with a literature review emphasizing the differential diagnosis with subacute granulomatous thyroiditis. To our knowledge, this is the first case report of painful HT treated with total thyroidectomy in the Korean literature.
Figures and Tables
Fig. 1
Moderate diffuse goiter is evident on initial presentation. The thyroid was exquisitely tender and very hard on palpation.
Fig. 2
Findings of thyroid ultrasonography (US) and computed tomography (CT) of the neck. A. Panoramic US shows diffuse goiter with hypoechic thyroid parenchyme with multiple ill-defined hypoechoic nodules (arrowheads). B. Intranodular vascularity is not visible on power doppler US. C and D. Pre- and post-contrast CT shows uneven enhancement of the thyroid with no discrete nodular lesions.
Fig. 3
Results of the cytologic examination. A. The smear is composed of lymphocytes and aggregate of follicular cells (Pap, ×100). B. High power view shows oxyphilic cells with abundant cytoplasm and prominent nucleoli (Pap, ×400).
Fig. 4
Serial follow-up of inflammatory markers and serum TSH shows the clinical response of the patient with therapy with glucocorticoids and levothyroxine.
Fig. 5
Histology confirms the diagnosis of Hashimoto's thyroiditis. A. The glandular architecture is destructed with dense lymphocytic infiltration and thick fibrous bundles (H&E stain, ×100). B. A typical germinal center is observed with destruction of normal follicular structure of the thyroid gland (H&E stain, ×100).
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