AĞRILI HASHİMOTO TİROİDİTİ: NADİR BİR OLGU SUNUMU

Kronik lenfositik tiroidit veya Hashimoto tiroiditi (HT) iyot eksikliğinin olmadığı bölgelerde guatr ve edinilmiş hipotiroidinin en sık nedeni olan, patogenezinde otoimmünite, genetik yatkınlık ve çevresel faktörlerin rol oynadığı inflamatuvar bir tiroid hastalığıdır. HT'de boyunda nadiren subakut granulamatöz tiroiditi (SAT) taklit eder şekilde ağrı ve hassasiyet olabilir. SAT genellikle kendi kendini sınırlayan bir durum olmasına rağmen semptomların şiddetli olduğu olgular streroid kullanımını gerektirebilir. SAT'da steroid kullanımı ile birlikte semptomlar kısa sürede azalır. Steroid tedavisi kesildikten sonra daha yüksek dozlarda tekrarlarlayan steroid tedavisi bazı olgularda nadiren gerekebilir. Ağrılı HT'de SAT'ın aksine, medikal tedaviye cevap ya geçicidir ya da yoktur ve/veya tekrarlayan relapslar görülür. Ağrılı HT olgularında medikal tedaviye yanıt alınamadığı durumlarda tiroidektomi bir seçenek olabilir Bu yazımızda, klinik ve laboratuvar özellikler nedeniyle ilk olarak SAT tanısıyla takip ettiğimiz, ancak daha sonra medikal tedaviye yanıtsızlık nedeniyle ağrılı HT olabileceğini düşündüğümüz ve cerrahi önerdiğimiz, patoloji sonucu HT ve mikropapiller tiroid karsinomu ile uyumlu olan nadir bir olguyu sunmayı amaçladık

Painful Hashimoto’s Thyroiditis: A Rare Case Report

Chronic lymphocytic thyroiditis, or Hashimoto’s thyroiditis (HT) is an inflammatory thyroid disease which is the most common cause of goiter and acquired hypothyroidism in iodine sufficient areas that autoimmunity, genetic predisposition and environmental factors play role in pathogenesis. Thyroid pain and tenderness may rarely be present in HT mimicking subacute granulamatous thyroiditis (SAT). Although SAT is a selflimiting condition, cases with severe symptoms may necessitate use of steroids. Symptoms reduce in a short time with use of steroids in SAT. Higher and repeated doses of steroids may be rarely necessary in some cases after stopping steroids. In contrary to SAT, patients with painful HT have only temporary or no response to medical treatment and/or show repeated relapses. Thyroidectomy may be an option in painful HT cases that do not response to treatment

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1. Zimmerman RS, Brennan MD, McConahey WM, Goellner JR, Gharib H. Hashimoto’s thyroiditis. An uncommon cause of painful thyroid unresponsive to corticosteroid therap. Annals of Internal Medicine. 1986;104(3):355–57.
2. Ohye H, Fukata S, Kubota S, Sasaki I, Takamura Y, Matsuzuka F, et al. Successful treatment for recurrent painful Hashimoto’s thyroiditis by total thyroidectomy. Thyroid. 2005;15(4):340–45.
3. Kon YC, DeGroot LJ. Painful Hashimoto’s thyroiditi as an indication for thyroidectomy: clinical characteristics and outcome in seven patients. Journal of Clinical Endocrinology and Metabolism. 2003;88(6): 2667–72.
4. Choia YS, Kim BK, Kwon HJ, Lee JS, Heo JJ, Jung SB, et al. Subacute thyroiditis with coexisting papillary carcinoma diagnosed by immediately repeat fine needle aspiration: a case report. J Med Cases. 2012;3(5):308-11.
5. Ucan B, Delibasi T, Arslan MS, Bozkurt NC, Demirci T, Ozbek M, et al. Papillary thyroid cancer case masked by subacute thyroiditis. Arq Bras Endocrinol Metabol. 2014;58(8):851-4.
6. Valentini RB, Macedo BM, Izquierdo RF, Meyer EL. Painless thyroiditis associated to thyroid carcinoma: role of initial ultrasonography evaluation. Arch Endocrinol Metab. 2015;1(1):1-6.
7. Shigemasa C, Ueta Y, Mitani Y, Taniguchi S, Urabe K, Tanaka T, et al. Chronic thyroiditis with painful tender thyroid enlargement and transient thyrotoxicosis. Journal of Clinical Endocrinology and Metabolism. 1990;70(2):385–90.
8. Mazza E, Quaglino F, Suriani A, Palestini N, Gottero C, Leli R, et al. Thyroidectomy for Painful Thyroiditis Resistant to Steroid Treatment: Three New Cases with Review of the Literature. Case Rep Endocrinol. 2015;2015. http://dx.doi. org/10.1155/2015/138327.
9. Seo HM, Kim M, Bae J, Kim JH, Lee JW, Lee SA, et al. A Case of Painful Hashimoto Thyroiditis that Mimicked Subacute Thyroiditis. Chonnam Med J. 2012;48(1):69-72.
10. Kim HK, Shin HJ, Kang HC. A case of painful hashimoto’s thyroiditis successfully treated with total thyroidectomy. J Korean Endocr Soc. 2008;23(6):438-43.
11. Ishihara T, Mori T, Waseda N, Ikekubo K, Akamizu T, Imura H. Histological, clinical and labratory findings of acute exacerbation of Hashimoto’s thyroiditis--comparison with those of subacute granulomatous thyroiditis. Endocrinol Jpn. 1987;34(6):831-41.
12. Cipolla C, Sandonato L, Graceffa G, Fricano S, Torcivia A, Vieni S, et al. Hashimoto thyroiditis coexistent with papillary thyroid carcinoma. Am Surg. 2005;71(10):874–8.
13. Liu LH, Bakhos R, Wojcik EM. Concomitant papillary thyroid carcinoma and Hashimoto’s thyroiditis. Semin Diagn Pathol. 2001;18(2):99–103.
14. Jankovic B, Le KT, Hershman JM. Clinical review: Hashimoto’s thyroiditis and papillary thyroid carcinoma: Is there a correlation? J Clin Endocrinol Metab. 2013;98(2):474–82.