J Korean Thyroid Assoc.  2015 May;8(1):113-116. 10.11106/cet.2015.8.1.113.

A Case of Severe Recurrent Painless Thyroiditis Requiring Thyroidectomy

• Park SH
• Nam-Goong
• Kim YI
• Kim YS
• Kim YM
• Kim ES

• KMID: 2149629
• DOI: http://doi.org/10.11106/cet.2015.8.1.113

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.

Keyword

Thyroid disease; Thyroid surgery; Thyrotoxicosis

MeSH Terms

Adult
Antibodies
Blood Sedimentation
Diagnosis
Female
Goiter
Humans
Iodine
Receptors, Thyrotropin
Recurrence
Thyroid Crisis
Thyroid Diseases
Thyroid Gland*
Thyroidectomy*
Thyroiditis*
Thyrotoxicosis
Antibodies
Iodine
Receptors, Thyrotropin

Figure

• 

  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.

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  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.

Reference

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