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.
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Fatourechi V, Aniszewski JP, Fatourechi GZ, Atkinson EJ, Jacobsen SJ (2003) Clinical features and outcome of subacute thyroiditis in an incidence cohort: Olmsted County, Minnesota, Study. J Clin Endocrinol Metab 88:2100–2105
Sicilia V, Mezitis S (2006) A case of acute suppurative thyroiditis complicated by thyrotoxicosis. J Endocrinol Invest 29:997–1000
Fatourechi MM, Hay ID, McIver B, Sebo TJ, Fatourechi V. Invasive fibrous thyroiditis (Riedel thyroiditis): the Mayo Clinic experience, 1976–2008 (2011). Thyroid 21:765–772
Doniach D, Hudson RV, Roitt IM (1960) Human auto-immune thyroiditis: clinical studies. Br Med J 1:365–373
Zimmerman RS, Brennan MD, McConahey WM, Goellner JR, Gharib H (1986) Hashimoto’s thyroiditis. An uncommon cause of painful thyroid unresponsive to corticosteroid therapy. Ann Intern Med 104:355–357
Shigemasa C, Ueta Y, Mitani Y, Taniguchi S, Urabe K, Tanaka T, Yoshida A, Mashiba H (1990) Chronic thyroiditis with painful tender thyroid enlargement and transient thyrotoxicosis. J Clin Endocrinol Metab 70:385–390
Nishihara E, Amino N, Ohye H, Ota H, Ito M, Kubota S, Fukata S, Miyauchi A (2009) Extent of hypoechogenic area in the thyroid is related with thyroid dysfunction after subacute thyroiditis. J Endocrinol Invest 32:33–36
Benbassat CA, Olchovsky D, Tsvetov G, Shimon I (2007) Subacute thyroiditis: clinical characteristics and treatment outcome in fifty-six consecutive patients diagnosed between 1999 and 2005. J Endocrinol Invest 30:631–635
Kon YC, DeGroot LJ (2003) Painful Hashimoto’s thyroiditis as an indication for thyroidectomy: clinical characteristics and outcome in seven patients. J Clin Endocrinol Metab 88:2667–2672
Ohye H, Fukata S, Kubota S, Sasaki I, Takamura Y, Matsuzuka F, Amino N, Kuma K, Miyauchi A, Kakudo K (2005) Successful treatment for recurrent painful Hashimoto’s thyroiditis by total thyroidectomy. Thyroid 15:340–345
Onoda N, Kato Y, Seki T, Kurimoto M, Takano K, Ito Y, Sato K (2009) Increased thyroid blood flow in the hypoechoic lesions in patients with recurrent, painful Hashimoto’s thyroiditis at the time of acute exacerbation. Endocr J 56:65–72
Gourgiotis L, Al-Zubaidi N, Skarulis MC, Papanicolaou DA, Libutti SK, Alexander HR, Merino MJ, Sarlis NJ (2002) Successful outcome after surgical management in two cases of the “painful variant” of Hashimoto’s thyroiditis. Endocr Pract 8:259–265
Ohye H, Nishihara E, Sasaki I, Kubota S, Fukata S, Amino N, Kuma K, Miyauchi A (2006) Four cases of Graves’ disease which developed after painful Hashimoto’s thyroiditis. Intern Med 45(6):385–389
Mazza E, Quaglino F, Suriani A, Palestini N, Gottero C, Leli R, Taraglio S (2015) Thyroidectomy for painful thyroiditis resistant to steroid treatment: three new cases with review of the literature. Case Rep Endocrinol 2015:138327
Kashyap L, Alsaheel A, Walvekar R, Simon L, Gomez R (2015) A rare case of painful goiter secondary to pediatric Hashimoto’s thyroiditis requiring thyroidectomy for pain control. Pediatr Rep 7:5914
Cappelli C, Pirola I, Gandossi E, Formenti AM, Agosti B, Castellano M (2014) Ultrasound findings of subacute thyroiditis: a single institution retrospective review. Acta Radiol 55:429–433
Konno S, Konno N, Yokobori M, Kazui K, Hase T, Uematsu T, Nishimura M (2002) Autoimmune thyroid disease accompanied by recurring episodes of painful thyroid ameliorated by thyroidectomy. J Endocrinol Invest 25(11):996–1000
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Rotondi, M., Capelli, V., Locantore, P. et al. Painful Hashimoto’s thyroiditis: myth or reality?. J Endocrinol Invest 40, 815–818 (2017). https://doi.org/10.1007/s40618-017-0655-5
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DOI: https://doi.org/10.1007/s40618-017-0655-5