Increased Thyroid Blood Flow in the Hypoechoic Lesions in Patients with Recurrent, Painful Hashimoto's Thyroiditis at the Time of Acute Exacerbation

We report two cases with painful Hashimoto's thyroiditis, who developed recurrent fever and painful thyroid. Glucocorticoid treatment was transiently successful but tenderness in the thyroid gland and fever developed when glucocorticoid was tapered. One patient underwent total thyroidectomy une...

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Bibliographic Details
Published in:Endocrine Journal 2009, Vol.56(1), pp.65-72
Main Authors: ONODA, Noritaka, KATO, Yoshiyuki, SEKI, Toshiro, KURIMOTO, Makiko, TAKANO, Kazue, ITO, Yukio, SATO, Kanji
Format: Article
Language:English
Subjects:
Acute Disease
Chronic Thyroiditis
Color flow Doppler sonography
Female
Hashimoto Disease - complications
Hashimoto Disease - diagnostic imaging
Humans
Middle Aged
Pain - complications
Pain - diagnostic imaging
Recurrence
Regional Blood Flow - physiology
Thyroid blood flow
Thyroid Function Tests
Thyroid Gland - blood supply
Thyroid Gland - diagnostic imaging
Thyroid Nodule - blood supply
Thyroid Nodule - complications
Thyroid Nodule - diagnostic imaging
Ultrasonography
Up-Regulation
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Summary:We report two cases with painful Hashimoto's thyroiditis, who developed recurrent fever and painful thyroid. Glucocorticoid treatment was transiently successful but tenderness in the thyroid gland and fever developed when glucocorticoid was tapered. One patient underwent total thyroidectomy uneventfully. As is well known, it is frequently difficult to make differential diagnosis between painful Hashimoto's thyroiditis and subacute thyroiditis particularly at the initial phase. Interestingly, color flow doppler sonography of patient 1 revealed an increased thyroid blood flow in the hypoechoic lesions at the time of acute exacerbation although the serum level of TSH was suppressed. In the other patient, thyroid blood flow was also increased mainly in the hypoechoic lesions when the serum level of TSH was moderately increased, and it disappeared completely after supplementation of prednisolone and L-T4. Since thyroid blood flow in subacute thyroiditis is always decreased, such an increased blood flow in the hypoechoic lesion may be one of clinical characteristics of painful Hashimoto's thyroiditis, and useful for differential diagnosis from subacute thyroiditis.
ISSN:0918-8959
1348-4540
DOI:10.1507/endocrj.K08E-194