Chonnam Med J.  2012 Apr;48(1):69-72. 10.4068/cmj.2012.48.1.69.

A Case of Painful Hashimoto Thyroiditis that Mimicked Subacute Thyroiditis

• Seo HM
• Kim M
• Bae J
• Kim JH
• Lee JW
• Lee SA
• Koh G
• Lee DH

• KMID: 2274886
• DOI: http://doi.org/10.4068/cmj.2012.48.1.69

Abstract

Hashimoto thyroiditis (HT) is an autoimmune thyroid disorder that usually presents as a diffuse, nontender goiter, whereas subacute thyroiditis (SAT) is an uncommon disease that is characterized by tender thyroid enlargement, transient thyrotoxicosis, and an elevated erythrocyte sedimentation rate (ESR). Very rarely, patients with HT can present with painful, tender goiter or fever, a mimic of SAT. We report a case of painful HT in a 68-year-old woman who presented with pain and tenderness in a chronic goiter. Her ESR was definitely elevated and her thyroid laboratory tests suggested subclinical hypothyroidism of autoimmune origin. (99m)Tc pertechnetate uptake was markedly decreased. Fine needle aspiration biopsy revealed reactive and polymorphous lymphoid cells and occasional epithelial cells with Hurthle cell changes. Her clinical symptoms showed a dramatic response to glucocorticoid treatment. She became hypothyroid finally and is now on levothyroxine therapy.

Keyword

Hashimoto thyroiditis; Subacute thyroiditis

MeSH Terms

Aged
Biopsy
Biopsy, Fine-Needle
Blood Sedimentation
Epithelial Cells
Female
Fever
Goiter
Hashimoto Disease
Humans
Hydrazines
Hypothyroidism
Lymphocytes
Sodium Pertechnetate Tc 99m
Thyroid Gland
Thyroiditis, Subacute
Thyrotoxicosis
Thyroxine
Hydrazines
Sodium Pertechnetate Tc 99m
Thyroxine

Figure

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  FIG. 1 Ultrasonography scan shows heterogeneously hypoechoic changes involving both thyroid lobes (glands). Both thyroid lobes (glands) were diffusely enlarged (A). A color Doppler image shows that blood flow is markedly decreased in the hypoechoic areas (B).

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  FIG. 2 Thyroid scintigraphy using 99mTc pertechnetate. Markedly decreased uptake of the radiotracer was seen in both lobes of the thyroid gland.

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  FIG. 3 The cytopathology of the thyroid gland. (A) The cytopathology of the thyroid gland revealed reactive and polymorphous lymphoid cell infiltrations (Papanicolaou's stain, ×100). (B) Occasional epithelial cells with Hürthle cell changes were mixed with lymphocytes, centroblasts, plasma cells, and macrophages (Papanicolaou's stain, ×200).

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