Thyroidectomy for Painful Thyroiditis Resistant to Steroid Treatment: Three New Cases with Review of the Literature
Thyroidal pain is usually due to subacute thyroiditis (SAT). In more severe forms prednisone doses up to 40 mg daily for 2-3 weeks are recommended. Recurrences occur rarely and restoration of steroid treatment cures the disease. Rarely, patients with Hashimoto’s thyroiditis (HT) have thyroidal pain...
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| Format: | Article |
| Language: | English |
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Wiley
2015-01-01
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| Series: | Case Reports in Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2015/138327 |
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| author | Enrico Mazza Francesco Quaglino Adolfo Suriani Nicola Palestini Cristina Gottero Renzo Leli Stefano Taraglio |
| author_facet | Enrico Mazza Francesco Quaglino Adolfo Suriani Nicola Palestini Cristina Gottero Renzo Leli Stefano Taraglio |
| author_sort | Enrico Mazza |
| collection | DOAJ |
| description | Thyroidal pain is usually due to subacute thyroiditis (SAT). In more severe forms prednisone doses up to 40 mg daily for 2-3 weeks are recommended. Recurrences occur rarely and restoration of steroid treatment cures the disease. Rarely, patients with Hashimoto’s thyroiditis (HT) have thyroidal pain (painful HT, PHT). Differently from SAT, occasional PHT patients showed no benefit from medical treatment so that thyroidectomy was necessary. We report three patients who did not show clinical response to prolonged high dose prednisone treatment: a 50-year-old man, a 35-year-old woman, and a 33-year-old woman. Thyroidectomy was necessary, respectively, after nine-month treatment with 50 mg daily, two-month treatment with 75 mg daily, and one-month treatment with 50 mg daily. The two women were typical cases of PHT. Conversely, in the first patient, thyroid histology showed features of granulomatous thyroiditis, typical of SAT, without fibrosis or lymphocytic infiltration, typical of HT/PHT, coupled to undetectable serum anti-thyroid antibodies. Our data (1) suggest that not only PHT but also SAT may show resistance to steroid treatment and (2) confirm a previous observation in a single PHT patient that increasing prednisone doses above conventional maximal dosages may not be useful in these patients. |
| format | Article |
| id | doaj-art-124a10e9eff249caaf358b044c3aa0d3 |
| institution | Kabale University |
| issn | 2090-6501 2090-651X |
| language | English |
| publishDate | 2015-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Endocrinology |
| spelling | doaj-art-124a10e9eff249caaf358b044c3aa0d32025-02-03T01:32:02ZengWileyCase Reports in Endocrinology2090-65012090-651X2015-01-01201510.1155/2015/138327138327Thyroidectomy for Painful Thyroiditis Resistant to Steroid Treatment: Three New Cases with Review of the LiteratureEnrico Mazza0Francesco Quaglino1Adolfo Suriani2Nicola Palestini3Cristina Gottero4Renzo Leli5Stefano Taraglio6Endocrinology and Metabolism Unit, Maria Vittoria Hospital, ASL TO2, 10144 Turin, ItalySurgery Unit, Maria Vittoria Hospital, ASL TO2, 10144 Turin, ItalyPathology Unit, Maria Vittoria Hospital, ASL TO2, 10144 Turin, Italy3rd General and Esophageal Surgical Unit, University of Torino, 10126 Turin, ItalyEndocrinology and Metabolism Unit, Maria Vittoria Hospital, ASL TO2, 10144 Turin, ItalySurgery Unit, San Giovanni Bosco Hospital, ASL TO2, 10154 Turin, ItalyPathology Unit, Maria Vittoria Hospital, ASL TO2, 10144 Turin, ItalyThyroidal pain is usually due to subacute thyroiditis (SAT). In more severe forms prednisone doses up to 40 mg daily for 2-3 weeks are recommended. Recurrences occur rarely and restoration of steroid treatment cures the disease. Rarely, patients with Hashimoto’s thyroiditis (HT) have thyroidal pain (painful HT, PHT). Differently from SAT, occasional PHT patients showed no benefit from medical treatment so that thyroidectomy was necessary. We report three patients who did not show clinical response to prolonged high dose prednisone treatment: a 50-year-old man, a 35-year-old woman, and a 33-year-old woman. Thyroidectomy was necessary, respectively, after nine-month treatment with 50 mg daily, two-month treatment with 75 mg daily, and one-month treatment with 50 mg daily. The two women were typical cases of PHT. Conversely, in the first patient, thyroid histology showed features of granulomatous thyroiditis, typical of SAT, without fibrosis or lymphocytic infiltration, typical of HT/PHT, coupled to undetectable serum anti-thyroid antibodies. Our data (1) suggest that not only PHT but also SAT may show resistance to steroid treatment and (2) confirm a previous observation in a single PHT patient that increasing prednisone doses above conventional maximal dosages may not be useful in these patients.http://dx.doi.org/10.1155/2015/138327 |
| spellingShingle | Enrico Mazza Francesco Quaglino Adolfo Suriani Nicola Palestini Cristina Gottero Renzo Leli Stefano Taraglio Thyroidectomy for Painful Thyroiditis Resistant to Steroid Treatment: Three New Cases with Review of the Literature Case Reports in Endocrinology |
| title | Thyroidectomy for Painful Thyroiditis Resistant to Steroid Treatment: Three New Cases with Review of the Literature |
| title_full | Thyroidectomy for Painful Thyroiditis Resistant to Steroid Treatment: Three New Cases with Review of the Literature |
| title_fullStr | Thyroidectomy for Painful Thyroiditis Resistant to Steroid Treatment: Three New Cases with Review of the Literature |
| title_full_unstemmed | Thyroidectomy for Painful Thyroiditis Resistant to Steroid Treatment: Three New Cases with Review of the Literature |
| title_short | Thyroidectomy for Painful Thyroiditis Resistant to Steroid Treatment: Three New Cases with Review of the Literature |
| title_sort | thyroidectomy for painful thyroiditis resistant to steroid treatment three new cases with review of the literature |
| url | http://dx.doi.org/10.1155/2015/138327 |
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