Endocrine Abstracts

JOINT1172

Subacute thyroiditis (De Quervain’s thyroiditis, granulomatous thyroiditis, giant cell thyroiditis) is an inflammation of the thyroid gland. The prevalence in the pediatric population is very rare. It is characterized by a triphasic course of transient mild thyrotoxicosis, lasting between 2 to 8 weeks, followed by hypothyroidism and thereafter by a return to euthyroid. During the thyrotoxic phase the thyroid follicles are damaged and the preformed thyroid hormone is released. In nuclear scan there is low thyroid uptake on nuclear scan, and the ultrasound of the thyroid gland shows areas of hypoechogenity with decreased or normal vascular flow by Dopler. ESR and CRP can be elevated. The patient has moderate to severe neck pain, with bilateral, and rare unilateral swelling of the thyroid gland and influenza-like symptoms. Differential diagnosis from malignancy can be difficult. The histopathological examination reveals patchy changes with varying stages of the disease. The classic granulomatous changes appear a little later in the disease with a large aggregation of lymphocytes, plasma cells, and large histiocytes in the damaged thyroid follicles. Multinucleated giant cells surround the fragments of colloid, and sometimes colloid can also be seen in the giant cells. Later there are many lymphocytic infiltrates and fibrosis. Rarely different histologic stages can be found in the same gland suggesting the confluence nature of destruction. The treatment may include non-steroidal anti-inflammatory drugs, beta-blockers, corticosteroids, opioid analgesics, or potassium iodide or iopanoic acid to reduce the conversion of T4 to the more biologically active form of thyroid hormone, T3. During the hypothyroid phase, thyroid hormone replacement may help alleviate hypothyroid symptoms. We present the case of a female 10-year-old patient who presented in our emergency department with goiter, fever and pain in the neck. Several weeks earlier she had tachycardia and restlessness. Thyroid function was normal, thyroglobulin was increased (8100ng/ml). An ultrasound showed a swollen left thyroid lobe with a volume of 7 ml. During the following days the patient developed jaundice. Blood tests showed elevated hepatic enzymes and serological examination showed increased IgM for Hepatitis A. A fine needle biopsy diagnostic confirmed the diagnoses of De Quervain’s thyroiditis. The patient received treatment with NSAID. This abstract reminds the reader of the rare condition of de Quervain thyroiditis. Furthermore, this is the first pediatric case report of de Quervain thyroiditis that was associated with Hepatitis A.