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.