1/25. Primary biliary cirrhosis associated with painless thyroiditis.A case of anti-mitochondrial antibody (AMA)-negative primary biliary cirrhosis (PBC) associated with painless thyroiditis is reported in a 47-year-old woman who diagnosed as PBC based on her elevated serum gamma-glutamyl transpeptidase and immunoglobulin m levels, as well as histological findings of destroyed bile ducts surrounded by mononuclear infiltrates in the biopsied liver. She was negative for AMA and had a depressed level of thyroid-stimulating hormone accompanied by increased free thyrosine, thyroxine and triiodothyronine levels and low titers of anti-microsomal and anti-thyroid peroxidase antibodies. Her thyroid disorder corresponded with painless thyroiditis. An association between PBC and hyperthyroidism is rare. Furthermore, an association between AMA-negative PBC and hyperthyroidism due to painless thyroiditis has not previously been reported.- - - - - - - - - - ranking = 1keywords = thyroiditis (Clic here for more details about this article) |
2/25. Atypical subacute thyroiditis: preliminary observations.Nine patients with painless or minimally painful subacute thyroiditis were seen between late June and October 2000. Six had a history of antecedant viral symptoms. Thyroid peroxidase antibodies were negative in eight patients tested; none had a family history of autoimmune thyroid disease. It is possible that these patients represent examples of postviral painless subacute thyroiditis (atypical subacute thyroiditis). In order to establish the nature of the syndrome, cytological examination, HLA typing, and long-term follow-up are necessary.- - - - - - - - - - ranking = 1keywords = thyroiditis (Clic here for more details about this article) |
3/25. Successful outcome after surgical management in two cases of the "painful variant" of Hashimoto's thyroiditis.OBJECTIVE: To describe two cases of the rare "painful variant" of Hashimoto's thyroiditis (HT) that were refractory to medical management and in which surgical intervention provided the definitive treatment. methods: We thoroughly review the clinical history as well as the laboratory, imaging, and surgical pathology data in these cases, and follow-up of the clinical response over time is provided. The relevant literature is also discussed. RESULTS: A 56-year-old woman, who had remotely undergone a left hemithyroidectomy and had been diagnosed with HT, sought further assessment because of neck pain and edema. Treatment with corticosteroids was partially successful but led to the development of Cushing's syndrome. A 32-year-old man had pain and swelling of the thyroid and was diagnosed with HT shortly thereafter. Levothyroxine treatment was unsuccessful. Both patients underwent thyroidectomy. Chronic lymphocytic thyroiditis (HT) with a variable degree of fibrosis was found on assessment of pathology specimens. The patients remained asymptomatic after the surgical procedure and did not require any further anti-inflammatory therapy. CONCLUSION: In selected cases, surgical treatment may become necessary for effective and permanent control of symptoms and local signs in painful HT. Access to experienced endocrine surgeons is important in order to avoid postoperative complications because the thyroid gland may be small or fibrosed in this rare variant of HT.- - - - - - - - - - ranking = 0.85714285714286keywords = thyroiditis (Clic here for more details about this article) |
4/25. Autoimmune thyroid disease accompanied by recurring episodes of painful thyroid ameliorated by thyroidectomy.A 71-yr-old female initially presented with clinical and biochemical hyperthyroidism with high TSH binding inhibitory immunoglobulin (TBII) and anti-thyroid peroxidase antibody (TPOAb) titers. Histological findings of the thyroid revealed hyperplasia with a focal germinal center, indicating Graves' disease and mild focal chronic thyroiditis. Four episodes of painful and tender thyroid occurred over the next 2 yr accompanied by acute inflammatory reactions. The first episode that developed while the patient was in a hyperthyroid state was soon followed by hypothyroidism associated with further increases in anti-thyroglobulin antibody (TGAb) and TPOAb titers. The subsequent 3 episodes occurred during the hypothyroid state, when the TGAb titer progressively increased with each episode. We performed subtotal thyroidectomy to prevent further episodes. Specimens obtained at thyroidectomy showed that extreme fibrosis had replaced the thyroid parenchyma with collapsed follicles and moderate lymphocyte infiltration. No further episodes occurred after thyroidectomy, and during a 3-yr follow-up period, TBII and thyroid-stimulating antibody (TSAb) disappeared and TGAb and TPOAb titers decreased. This case report provides further evidence supporting the notion that thyroid epithelial destruction progresses during relatively short periods of recurrent painful thyroid and that thyroidectomy helps patients affected by this condition that are unresponsive to other treatment strategies.- - - - - - - - - - ranking = 0.14285714285714keywords = thyroiditis (Clic here for more details about this article) |
5/25. Subacute thyroiditis in children: patient report and review of the literature.Subacute thyroiditis is extremely rare during childhood. We treated a 10 year-old prepubertal girl who presented with typical clinical features of subacute thyroiditis. Considering this case and previous reports in children, we characterized the clinical features of this disorder as it occurs in childhood. In contrast to the predominance of subacute thyroiditis in adults, the incidence of subacute thyroiditis is lower than that of acute suppurative thyroiditis in children. This may cause difficulty with differential diagnosis, particularly when leukocytosis is present or the lesion is localized to the left lobe. ultrasonography can be helpful in differentiation.- - - - - - - - - - ranking = 1.2857142857143keywords = thyroiditis (Clic here for more details about this article) |
6/25. Possible induction of Graves' disease and painless thyroiditis by gonadotropin-releasing hormone analogues.Prolonged administration of gonadotropin-releasing hormone (GnRH) analogues induce a decrease in serum estrogen level, which may aggravate subclinical or mild autoimmune thyroid disease. Two patients developed Graves' thyrotoxicosis in association with an increase in anti-thyrotropin (TSH) receptor antibody activities at 4 months after initiation of buserelin acetate. GnRH analogue therapy was discontinued at the time of diagnosis but it took more than 2 years of methimazole therapy to obtain remission of Graves' disease. Another patient developed painless thyroiditis in association with an increase in antithyroid microsomal antibodies at 4 months after initiation of leuprolide acetate. These results indicate that GnRH analogues possibly induce clinical onset of Graves' thyrotoxicosis or destruction-induced thyrotoxicosis. Clinicians should be aware of this phenomenon. All patients who are to receive GnRH analogue therapy should be examined for antithyroid antibodies and family history of autoimmune thyroid disease, and should be followed accordingly.- - - - - - - - - - ranking = 0.71428571428571keywords = thyroiditis (Clic here for more details about this article) |
7/25. Painful thyroid gland: an atypical presentation of Graves' disease.An adolescent with Graves' disease presented with acute painful swelling of the thyroid gland and overlying erythema simulating acute suppurative or subacute thyroiditis. She had an elevated radioactive iodine uptake, thyroid stimulating antibodies, thyrotrophin binding inhibiting immunoglobulins, and a normal sedimentation rate and leucocyte count. The course of the thyrotoxicosis and painful thyroid was protracted, and the pain and tenderness of the thyroid recurred on two subsequent relapses.- - - - - - - - - - ranking = 0.14285714285714keywords = thyroiditis (Clic here for more details about this article) |
8/25. Secondary infection and ischemic necrosis after fine needle aspiration for a painful papillary thyroid carcinoma: a case report.BACKGROUND: Papillary thyroid carcinoma (PTC) is often asymptomatic and rarely presents as a painful goiter. Further, the thyroid gland is not easily infected. Therefore, acute suppurative thyroiditis (AST) is unusual. PTC is also seldom combined with AST. We report a case of painful PTC with secondary infection after fine needle aspiration (FNA). CASE: A 19-year-old girl complained of a painful goiter without skin change after an episode of upper airway infection. PTC was diagnosed according to the FNA cytology (FNAC) at another hospital. The goiter became more painful after FNA. The patient's second FNAC at our hospital revealed only many polymorphonuclear leukocytes (PMNs). Antibiotic treatment ameliorated the pain, but the goiter persisted. The third FNAC revealed some PMNs and papillary carcinomatous cells. After total thyroidectomy, pathology revealed ischemic necrosis with a focal PMN aggregation around the needle track and papillary carcinomatous cells nearby. According to the time sequence, secondary infection after FNA was suspected. CONCLUSION: A painful goiter is an unusual presentation of PTC. Although FNAC is feasible for studying a thyroid lesion, malignant cells might be missed when secoandary injection and ischemic necrosis occur after FNA. Therefore, aseptic procedures are necessary to prevent bacteria from seeding into the thyroid.- - - - - - - - - - ranking = 0.14285714285714keywords = thyroiditis (Clic here for more details about this article) |
9/25. Painless thyrotoxic thyroiditis in association with ovarian and adrenal failure.Polyglandular autoimmune syndrome (PGAS) type II is a disorder characterized by Addison's disease, autoimmune thyroid disease, and diabetes mellitus. In this report, a 19-year-old woman having Addison's disease, ovarian failure, painless thyroiditis, and an HLA type characteristic of PGAS II is described. Painless thyroiditis has been considered recently to have an autoimmune basis and has been reported previously in another patient with Addison's disease. The otherwise characteristic features of the patient in this case allow her to be classified as having PGAS II, thereby expanding the scope of reported autoimmune thyroid disorders in PGAS II.- - - - - - - - - - ranking = 0.85714285714286keywords = thyroiditis (Clic here for more details about this article) |
10/25. Post-partum thyroiditis can be painful.A patient with post-partum thyroiditis is described. She was a 22 year old with a negative family history of autoimmune thyroid disease who was noted to have a high titre of antithyroid microsomal antibody during pregnancy. She developed mild hyperthyroidism 8 weeks post-partum but at 12 weeks she had a mildly painful enlarged thyroid gland. At 20 weeks post-partum she had severe thyroidal pain with dysphagia. The thyroid was exquisitely tender to palpation. She was treated with L-thyroxine and the pain resolved within 4 weeks. This is the first report documenting pain in the thyroid as a feature of post-partum thyroiditis.- - - - - - - - - - ranking = 0.85714285714286keywords = thyroiditis (Clic here for more details about this article) |
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