Subacute or hashimoto thyroiditis? a diagnostic dilemma: case report
R. Popovici, D. Ciobanu, L. Ionescu, J. Idriceanu, I. Vasiliu, I. Potorac, E. Bivoleanu, C. Cristea, V. Mogos & C. Vulpoi
Introduction: Subacute thyroiditis (SAT) is characterized by cervical pain. Rarely, other thyroid diseases, like Hashimotos thyroiditis (HT), may be associated with cervical pain, leading to confusions with SAT. We report a particular case of painful goitre.
Case report: D Maria, 50 years old, presented with cervical pain, low grade fever, inflammatory syndrome (ESR=132 mm/1 h), and was diagnosed with SAT. Thyroid function was normal. Ultrasound (US) aspect of goiter (30 ml) was in homogeneous, hypoechoic, pseudo-nodule in the left lobe. Treatment with prednisone (30 mg/day) induced a rapid improvement of pain and inflammatory syndrome (6 weeks after ESR=26 mm/1 h). After 3 months, with 10 mg Prednisone/day, she had a relapse (thyroid pain, ESR=95 mm/1 h) with new remission after increasing dose followed, 2 months later, by a new episode of severe cervical pain and high ESR=87 mm/1 h. Euthyroidism, positive antiTPO antibodies. Thyroid US revealed a hypoechoic irregular left nodule, with suspect cytology. This aspect and the intolerance to anti-inflammatory drugs have led to surgery quasitotale thyroidectomy. Histology described an association of lymphocytic thyroiditis with giant cells. Postoperative hypothyroidism is compensated until present with 100 mg LT4/day.
Discussion: The overlap of symptoms may determine the confusion between SAT and HT. Painful HT is rare; in most literature cases the response to anti-inflammatory treatment was transitory and surgery was imposed by the evolution of the disease. The histological exam of our case suggests a rare association between the two forms of thyroiditis. We may speculate that inflammation of SAT has determined an immune response inducing the appearance of TH.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.