Painful Hashimoto’s thyroiditis: myth or reality?

Abstract

Neck pain is a common complain, being in most cases due to non-thyroidal causes. However, a minority of patients suffer from painful thyroid diseases. Among them, sub-acute thyroiditis (SAT) is the most frequent one. Rare thyroid-related causes of neck pain include hemorrhage within a thyroid nodule as well as Riedel's thyroiditis and suppurative thyroiditis. In the last 30 years, a few cases of a painful variant of Hashimoto's thyroiditis (HT) have been described. Biochemical, ultrasound, and histologic features were clearly suggestive for HT in all of the published cases and definitely ruled out the diagnosis of SAT. While sound descriptions of painful HT are present in the literature, it is important to emphasize that only 20 cases were reported from the year 2000 until now. The condition, however, is clinically relevant because neck pain was reported to be refractory both to steroids and to other analgesic drugs, being thyroidectomy the only effective treatment for pain relief in these patients. This short review analyzes currently available data supporting a role for HT as a rare cause of neck pain.

Follicle-stimulating Hormone-secreting Pituitary Adenoma Accompanied by Painful Thyroiditis

“…Hashimoto thyroiditis is an autoimmune thyroid disorder that usually presents as a diffuse, nontender goiter, whereas subacute thyroiditis is an uncommon disease that is characterized by tender thyroid enlargement, transient thyrotoxicosis, and elevated inflammatory markers. Mimicking subacute thyroiditis, patients with Hashimoto thyroiditis rarely but occasionally present with tender goiter and a fever, known as painful Hashimoto thyroiditis (3).…”

Thyrotoxicosis secondary to thyroiditis following SARS-CoV-2 infection

“…A rare variant of painful Hashimoto's has been described but, contrary to our patient, painful Hashimoto's typically features an elevated serum level of thyroid antibodies (antithyroperoxidase or antithyroglobulin). 7 Thyrotoxicosis in subacute thyroiditis is the result of the destruction of thyroid follicles and the release of thyroid hormones, as opposed to increased production of FT3 and FT4 as seen in Graves' disease. The destruction of thyroid follicles is represented by the absence of uptake on the thyroid scintigram in our patient.…”

A Case of Dynamic Evolution of Thyrotoxicosis on Follow-up

“…Patients usually return to euthyroidism within 6 to 12 months. [2][3][4] The present study describes a 55-year female patient with SAT, who had a unique dynamic evolution of thyroid function, along with changes in the level of antithyroglobulin antibody, which is rarely reported.…”