A Case of Severe Recurrent Painless Thyroiditis Requiring Thyroidectomy

So Hyun Park; Il Seong Nam-Goong; Young Il Kim; Yun Sun Kim; Yung Min Kim; Eun Sook Kim

doi:10.11106/cet.2015.8.1.113

Journal List > J Korean Thyroid Assoc > v.8(1) > 1056580

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Park, Nam-Goong, Kim, Kim, Kim, and Kim: A Case of Severe Recurrent Painless Thyroiditis Requiring Thyroidectomy

Original Article

Clin Exp Thyroidol 2015;8(1):113-116.

Published online: 4 May 2015

DOI: https://doi.org/10.11106/cet.2015.8.1.113

A Case of Severe Recurrent Painless Thyroiditis Requiring Thyroidectomy

So Hyun Park¹, Il Seong Nam-Goong¹, Young Il Kim¹, Yun Sun Kim², Yung Min Kim³, Eun Sook Kim¹

Departments of Endocrinology, Ulsan University Hospital, College of Medicine University of Ulsan, Ulsan, Korea

General Surgery, Ulsan University Hospital, College of Medicine University of Ulsan, Ulsan, Korea

Pathology, Ulsan University Hospital, College of Medicine University of Ulsan, Ulsan, Korea

Correspondence: Eun Sook Kim, MD, PhD, Department of Endocrinology, Ulsan University Hospital, 877 Bangeojinsunhwandoro, Dong-gu, Ulsan 682-714, Korea Tel: 82-52-250-7020, Fax: 82-52-250-7048, E-mail: endo10@daum.net

Received 26 August 2014 Accepted 1 December 2014

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The course of painless thyroiditis is usually transient with a thyrotoxicosis phase that lasts for 2 months before recovery. Therefore, no treatment is required. This case is unusual because of the recurrence and severity of thyrotoxicosis, which required surgery of the thyroid gland to prevent a thyrotoxic crisis. A 43-year-old female who presented with severe thyrotoxicosis was found to have low radioactive iodine uptake, negative test results for TSH receptor antibodies, normal erythrocyte sedimentation rate and diffuse goiter without pain or tenderness; these findings suggested a diagnosis of painless thyroiditis. She was treated for relapsed painless thyroiditis for 10 years. However, in May 2014, she developed recurrent painless thyroiditis with severe thyrotoxicosis; free T4 41.5 ng/dL, TSH <0.005 mlU/mL. Owing to the severity and recurrence of thyrotoxicosis, total thyroidectomy was performed to prevent a thyrotoxic storm.

Keywords: Thyroid disease, Thyroid surgery, Thyrotoxicosis

References

1. Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med. 2003; 348(26):2646–55.

2. Woolf PD. Transient painless thyroiditis with hyperthyroidism: a variant of lymphocytic thyroiditis? Endocr Rev. 1980; 1(4):411–20.

3. Umena S, Takano T, Iijima T, Hidaka Y, Yagoro A, Takai S. et al. A case of repeated painless thyroiditis followed by Graves' disease. Endocr J. 1995; 42(6):821–6.

4. Na GJ, Kim JH, Park SY, Kim KW, Ko HJ, Jeon SW. et al. A case of painless thyroiditis followed by Graves' disease Endocrinol Metab. 2012; 27(2):147–50.

5. Mizukami Y, Michigishi T, Hashimoto T, Tonami N, Hisada K, Matsubara F. et al. Silent thyroiditis: a histologic and immunohistochemical study. Hum Pathol. 1988; 19(4):423–31.

6. Agarwal A, Mishra A, Mishra SK, Agarwal G, Mithal A, Krishnani N. Recurrent painless thyroiditis requiring total thyroidectomy. J Assoc Physicians India. 2000; 48(3):367–8.

7. Mitsunaga M, Hasegawa K, Nakagawa O, Nakashima Y, Miyoshi M, Suzuki S. et al. Recurrent transient thyrotoxicosis with painless thyroiditis– a case report. Acta Med Okayama. 1979; 33(1):43–51.

8. Ohye H. Recurrent severe painless thyroiditis requiring multiple treatments with radioactive iodine. Thyroid. 2008; 18(11):1231–2.

9. Park HM. Painless thyroiditis and radioactive iodine therapy. Thyroid. 2009; 19(9):1013.

10. Ishii H, Takei M, Sato Y, Ito T, Ito K, Sakai Y. et al. A case of severe and recurrent painless thyroiditis requiring thyroidectomy. Med Princ Pract. 2013; 22(4):408–10.

Fig. 1.

Thyroid scan with Tc-99m pertechnetate showed decreased uptake as 0.16% (0.24-3.34%) at 2004.

Fig. 2.

Clinical course of painless thyroiditis from June 2004 to July 2014. OP: operation, TSH: thyroid stimulating hormone.

Fig. 3.

Thyroid ultrasound in transverse view showed diffuse enlargement with heterogeneous parenchyma of thyroid gland.

Fig. 4.

(A) Pathology of the resected thyroid gland (×40). Hematoxylin & Eosin staining showing lymphocyte infiltration in the follicular epithelium. (B) High power microscopic view (×200). Surrounding lymphoid follicular formation; lymphocyte infiltration was evident in the follicular epithelium.

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