Graves disease presenting as painful thyroiditis

Abstract

Hyperthyroidism associated with subacute (painful, viral) thyroiditis is well-recognized as a clinical entity; the thyroid gland in Graves disease is minimally, if ever, tender and painful. We describe a 10-year-old girl with hyperthyroidism whose initial clinical presentation was predominantly a painful, tender goiter. Graves disease was established by high uptake of 131I with a diffuse pattern of distribution of radioactivity on scan and the presence of thyroid-stimulating antibody. Thyrotropin-binding inhibiting IgG and antibody to thyroid microsomal antigen were both positive. She responded well to treatment with propylthiouracil and had spontaneous regression of her thyroid pain. The cause of the severe pain and tenderness remains speculative.

Graves' Disease Presenting as Painful Goiter: A Case Report and Review of the Literature

“…Hyperthyroidism with diffusely increased 131 I uptake and presence TSI suggested a diagnosis of Graves' disease. She responded well to treatment with antithyroid medication [ 1 ]. Stanley JM et al reported a case of 13-year-old girl presented with acute painful swelling of the thyroid gland and overlying erythema.…”

“…He responded well to treatment with methimazole and prednisolone [ 3 ]. One possible explanation of the extreme thyroid pain is unusual rapid gland growth with some restrictive element contributed by the features of autoimmune thyroiditis [ 1 ].…”

“…It is characterized by a diffusely enlarged thyroid gland with a high titer of thyroid-stimulating antibodies (TSI) and an increased uptake of radioiodine by the thyroid gland. A painful and tender thyroid gland is an uncommon feature of Graves' disease [ 1 - 3 ]. We present a case of Graves' disease where the patient primarily presented with complaints of pain and tenderness in the region of the thyroid gland without evidence of sub-acute thyroiditis.…”

Painful thyroid gland: an atypical presentation of Graves' disease

“…It is of interest that upon relapse the pain and tenderness but not the erythema recurred. One other case of painful thyroid in Graves' disease in a child has been reported (Alves et al, 1989). That patient had no erythema of the skin and the initial thyroid antibodies were unequivocally positive.…”

An Investigation of Oxidative Stress and Thiol/Disulphide Homeostasis in Graves’ Disease

“…Graves’ disease, which is usually associated with goitre and ophthalmopathy, is an autoimmune thyroid disorder characterized by hyperthyroidism (increased thyroid hormone secretion) [1]. Graves’ disease is the most prevalent reason of hyperthyroidism [2].…”