Painless thyroiditis followed by autoimmune disorders of the thyroid. A case report with biopsy

Abstract

Painless thyroiditis is a clinical entity of unknown origin. We report a case of a woman first seen with painless thyroiditis, who consequently developed a true hyperthyroidism, then exophthalmos and finally permanent hypothyroidism. The biopsy findings and serum antibodies determinations at the final stage were of Hashimoto's thyroiditis. The case is discussed and the need for a long follow-up after a painless thyroiditis is stressed.

Recurrent Hyperthyroidism Following Postpartum Thyroiditis in a Woman with Hashimoto's Thyroiditis

“…In contrast to all of the above reported cases, [4][5][6][7][8] our patient experienced two consecutive episodes of hyperthyroidism following PPT. Her first episode occurred 12 months after her first delivery and the recurrent hyperthyroidism occurred 8 months after recovery.…”

“…In contrast to the high incidence of PPT or recurrence of GD in the postpartum period in women with a history of GD, 2,10) the development of endogenous hyperthyroidism in patients with a history of PPT, as in our case, is infrequent; however, it has been reported previously in the literature. [4][5][6][7][8] These patients were first diagnosed with PPT within six months after delivery, and subsequently developed GD after PPT (Table 2).…”

“…The development of postpartum thyroiditis (PPT) in patients with a history of Graves' disease (GD) appears to be common during the postpartum period; 2,3) however, the development of GD in patients with a history of PPT and no prior history of GD appears to be far less common. [4][5][6][7][8] Here, we report a case of recurrent hyperthyroidism associated with GD between two episodes of PPT in a woman diagnosed with subclinical hypothyroidism prior to pregnancy.…”

Stimulation of thyroid‐stimulating hormone (TSH) receptor antibody production following painless thyroiditis

“…We (Iitaka et al, 1998) and others (Strakosch et al, 1978;Werner, 1979;Wall et al, 1982;Tamai et al, 1991) have previously reported that apparently normal people can produce TSHR Abs after destruction of the thyroid gland by subacute thyroiditis. In fact, previous reports have demonstrated the development or exacerbation of GD following the onset of PT (Sartani et al, 1980;Taylor et al, 1982;Iitaka et al, 1991;Sarlis et al, 1997;Shorey et al, 1998). PT has a destructive effect on the thyroid gland, which may trigger the production of TSHR Abs resulting in the development or exacerbation of GD.…”

Thyrotoxicosis Due to the Simultaneous Occurrence of Silent Thyroiditis and Graves' Disease

“…The development of ST in patients with a history of GD appears to be common during the postpartum period (11,12), but has also been documented in nonpregnancy related cases (13). The development of GD with a history of ST however, appears to be far less common (14,15). In these cases, it is possible that the release of thyroidal antigens during the destructive process triggers GD in a genetically susceptible individual (4,16).…”