Int J Thyroidol.  2021 May;14(1):50-54. 10.11106/ijt.2021.14.1.50.

Painful Hashimoto Thyroiditis in a 7-Year-Old Girl: Differential Diagnosis and Medical Treatment

• Park G
• Song K
• Shin HJ
• Chae HW

• KMID: 2516166
• DOI: http://doi.org/10.11106/ijt.2021.14.1.50

Abstract

Painful Hashimoto thyroiditis (HT) is a rare pediatric condition. Because of the rarity of painful HT, it can be misdiagnosed as other thyroid diseases, and there is limited evidence regarding its clinical course and treatment. A 7-year-old girl presented to the emergency room with neck pain. A physical examination revealed diffusely enlarged thyroid gland with firm consistency and without tenderness. Her serum free thyroxine level was decreased and levels of thyroid-stimulating hormone, thyroglobulin antibody, and thyroid-stimulating antibody were elevated. The ultrasonography revealed a diffusely enlarged thyroid gland with homogeneously hypoechoic parenchyma and lobulated contours. She was diagnosed with painful HT based on the clinical presentations, laboratory tests, and ultrasonography findings, and was treated with a steroid, levothyroxine, and nonsteroidal anti-inflammatory drugs, after which her clinical symptoms improved dramatically. We should consider the possibility of painful HT in children with neck pain; HT could be treated with medical treatment.

Keyword

Hypothyroidism; Hashimoto disease; Neck pain; Goiter; Child

Figure

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  Fig. 1 Thyroid ultrasound images. (A) Ultrasonographic findings revealed a diffusely enlarged thyroid gland with homogeneously mild hypoechoic changes involving the entire area of both thyroid glands with lobulated contour. (B) Color Doppler ultrasonography showed diffuse hypervascularity without hypovascular portion in the hypoechoic lesion.

Reference

References

1. Vukovic R, Zeljkovic A, Bufan B, Spasojevic-Kalimanovska V, Milenkovic T, Vekic J. 2019; Hashimoto thyroiditis and dyslipidemia in childhood: a review. Front Endocrinol (Lausanne). 10:868. DOI: 10.3389/fendo.2019.00868. PMID: 31920978. PMCID: PMC6914680.

2. Seo HM, Kim M, Bae J, Kim JH, Lee JW, Lee SA, et al. 2012; A case of painful Hashimoto thyroiditis that mimicked subacute thyroiditis. Chonnam Med J. 48(1):69–72. DOI: 10.4068/cmj.2012.48.1.69. PMID: 22570820. PMCID: PMC3341442.

3. Krakovitz P, Cairns C, Schweiger BM, Burkey B. 2018; Surgical management of neck pain and headache associated with pediatric hashimoto's thyroiditis. Laryngoscope. 128(9):2213–7. DOI: 10.1002/lary.27099. PMID: 29726593.

4. Anderson L, Middleton WD, Teefey SA, Reading CC, Langer JE, Desser T, et al. 2010; Hashimoto thyroiditis: Part 1, sonographic analysis of the nodular form of Hashimoto thyroiditis. AJR Am J Roentgenol. 195(1):208–15. DOI: 10.2214/AJR.09.2459. PMID: 20566818.

5. Kahaly GJ, Diana T, Glang J, Kanitz M, Pitz S, Konig J. 2016; Thyroid stimulating antibodies are highly prevalent in Hashimoto's thyroiditis and associated orbitopathy. J Clin Endocrinol Metab. 101(5):1998–2004. DOI: 10.1210/jc.2016-1220. PMID: 26964732.

6. Takasu N, Yamashiro K, Ochi Y, Sato Y, Nagata A, Komiya I, et al. 2001; TSBAb (TSH-stimulation blocking antibody) and TSAb (thyroid stimulating antibody) in TSBAb-positive patients with hypothyroidism and Graves' patients with hyperthyroidism. Horm Metab Res. 33(4):232–7. DOI: 10.1055/s-2001-14942. PMID: 11383928.

7. Zdraveska N, Kocova M. 2012; Hashimoto thyroiditis in childhood–review of the epidemiology, genetic susceptibility and clinical aspects of the disease. Maced J Med Sci. 5(3):336–45. DOI: 10.3889/MJMS.1857-5773.2012.0247.

8. Peng CC, Huai-En Chang R, Pennant M, Huang HK, Munir KM. 2020; A literature review of painful Hashimoto thyroiditis: 70 published cases in the past 70 years. J Endocr Soc. 4(2):bvz008. DOI: 10.1210/jendso/bvz008. PMID: 32047869. PMCID: PMC7003982.

9. Lee MY, Lam WW, Wong WY. 2016; Subacute thyroiditis-an often overlooked sonographic diagnosis: report of 3 cases. J Ultrasound Med. 35(5):1095–100. DOI: 10.7863/ultra.15.05052. PMID: 27022173.

10. Park SY, Kim EK, Kim MJ, Kim BM, Oh KK, Hong SW, et al. 2006; Ultrasonographic characteristics of subacute granulomatous thyroiditis. Korean J Radiol. 7(4):229–34. DOI: 10.3348/kjr.2006.7.4.229. PMID: 17143025. PMCID: PMC2667608.

11. Admoni O, Rath S, Almagor T, Elias-Assad G, Tenenbaum-Rakover Y. 2020; Long-term follow-up and outcomes of autoimmune thyroiditis in childhood. Front Endocrinol (Lausanne). 11:309. DOI: 10.3389/fendo.2020.00309. PMID: 32582023. PMCID: PMC7291832.