Some patients with Hashimoto's thyroiditis
have persistent thyroid pain that is relieved by thyroidectomy
(November 2003)
The background of the study. Patients
with Hashimoto's thyroiditis usually have painless thyroid enlargement,
but a few have chronic pain in the thyroid region. This case series
describes seven women with Hashimoto's thyroiditis who had thyroid
pain and tenderness and who underwent thyroidectomy to relieve the
symptoms.
Summary of cases. These seven women
with Hashimoto's thyroiditis, who had prolonged thyroid pain and
tenderness, were encountered over a period of seven years at a busy
thyroid clinic. Some had constant pain, but in others the pain was
intermittent. The pain was sometimes asymmetric, and it radiated
to the ears or jaw in several women. The duration of pain varied
from 1 month to 3 years.
At initial evaluation, all the women had a goiter, five had normal
thyroid function, one was overtreated with thyroxine, and one had
subclinical hypothyroidism. Five women had high serum titers of
antithyroid microsomal antibodies. Fine-needle-aspiration biopsy,
done in five, revealed lymphocytic thyroiditis in four and was inconclusive
in one. All seven women were treated with thyroxine at some time,
sometimes with temporary benefit. Most also were treated with nonsteroidal
antiinflammatory drugs and glucocorticoids, with some, but often
only temporary, benefit.
All the women underwent subtotal or near-total thyroidectomy 0.5
to 6 years after the onset of pain. Histologic examination of the
thyroid revealed lymphocytic thyroiditis, sometimes with extensive
fibrosis and lymphoid follicles. All patients were then treated
with thyroxine. Four had complete relief of pain, one had partial
relief, and two improved but later had relapses.
The conclusions of the study. Some
patients with Hashimoto's thyroiditis have persistent thyroid pain
that is relieved by thyroidectomy.
The original article. Kon YC, DeGroot
LJ. Painful Hashimoto's thyroiditis as an indication for thyroidectomy:
clinical characteristics and outcome in seven patients. J Clin Endocrinol
Metab 2003;88:2667-72.
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