Endocrine Abstracts

Introduction: De Quervain’s Thyroiditis (DQT) is a self-restriction inflammatory disease of the thyroid gland that presents severe pain localized in the neck. But few cases of a painful variant of Hashimoto’s thyroiditis (HT) have been described as well. Thyroid ultrasound (US) may reveal in homogeneous hypoechoic pattern in both conditions.

Case: A 51-year old woman was admitted to the Hospital of Lithuanian University of Health Sciences, Kauno klinikos with the pain in anterior region of the neck and throat. Laboratory tests: erythrocyte sedimentation rate (ERS) 34 mm/h (normal 0–13), C-reactive protein 3.82 mg/l (0–10), TSH 0.11 mIU/l (0.27–4.2), FT4 17.95 pmol/l (12–22), FT3 4.2 (3.34–5.14), anti-TSH-R 3.9 U/l (n<9), anti-TPO 7 kU/l (0–12), anti-Tg 316 kU/l (0–100). US revealed decreased echogenicity, nonhomogeneous thyroid parenchyma and heterogeneous hypoechoic focal areas in both lobes. The treatment with nonsteroidal anti-inflammatory drug (NSAID) was started with gradually reduced dose. However, mildly elevated ERS and suppressed TSH remained. US showed the same size of focal area 2 months later. For the differential diagnosis (DD) of thyroid cancer (TC), painful HT and DQT coexisting with HT, fine needle aspiration biopsy (FNAB) was performed. FNAB showed changes compatible with DQT. It was decided to continue the treatment with NSAID and prednisolone was prescribed while gradually reducing the dose. The patient’s condition has improved significantly. During follow-up appointment, after 3 months, thyroid hormones were in normal range and US showed decreased size of heterogeneous hypoechoic focal areas in both lobes.

Conclusions: Coexistence of DQT and HT is very rare and the diagnosis can be challenging. Clinical manifestation and ultrasonography results may be similar in both conditions. FNAB may be required for DD. The complete establishment of US patterns may last for one or two years.