Endocrine Abstracts

Hashimoto’s thyroiditis (HT) is usually characterized by goiter and/or hypothyroidism. Thyroid pain and tenderness are rare and suggest an alternative diagnostic of subacute thyroiditis (SAT).

We present two cases of painful HT, who had temporary relief with corticosteroids and required surgical intervention for persistent pain. Both patients were middle-aged women with painful goiter, fever, and inflammatory syndrome. Thyroid function was normal, and ultrasonography showed a hypoechoic inhomogeneous pattern. Corticosteroid treatment was started with rapid amelioration of both pain and inflammatory syndrome, but with relapse in about two months. First patient (MR, 52 y) had moderate hypothyroidism and restarted the corticosteroid treatment in association with l-thyroxine, with a new amelioration. Six months later, she presented relapse of intense pain with inflammatory syndrome, with no response to corticoids, and she was operated. Pathology confirmed lymphocytic thyroiditis, with diffuse fibrosis. She had a favourable evolution for the next 10 years. On her second episode, second patient (MD, 50 y) had high antibodies titre with normal thyroid function. Corticosteroids induced a new amelioration but with relapse at smaller doses. Ultrasonography showed a left thyroid nodule with suspicious cytology after FNAB. She was operated, with favourable evolution until nowadays. Pathology found a rare association of lymphocytic thyroiditis with giant cells, suggesting the association of subacute thyroiditis.

The overlapping of the symptoms may lead to confusion between painful HT and SAT. Thyroid function is variable and antibodies titre are not always elevated. There are few small series of painful HT published in the literature, in which surgery was imposed by the evolution of the disease. In front of a clinical picture of SAT with no or little response to anti inflammatory treatment, painful HT must be considered. Thyroidectomy seams to be the best option, with relief of the symptoms.