AĞRILI HASHİMOTO TİROİDİTİ: NADİR BİR OLGU SUNUMU Painful Hashimoto’s Thyroiditis: A Rare Case Report
Kronik lenfositik tiroidit veya Hashimoto tiroiditi (HT) iyot eksikliğinin olmadığı bölgelerde guatrve edinilmiş hipotiroidinin en sık nedeni olan, patogenezinde otoimmünite, genetik yatkınlık veçevresel faktörlerin rol oynadığı inflamatuvar bir tiroid hastalığıdır. HT’de boyunda nadiren subakutgranulamatöz tiroiditi (SAT) taklit eder şekilde ağrı ve hassasiyet olabilir. SAT genellikle kendikendini sınırlayan bir durum olmasına rağmen semptomların şiddetli olduğu olgular streroid kullanımınıgerektirebilir. SAT’da steroid kullanımı ile birlikte semptomlar kısa sürede azalır. Steroidtedavisi kesildikten sonra daha yüksek dozlarda tekrarlarlayan steroid tedavisi bazı olgularda nadirengerekebilir. 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 durumlardatiroidektomi bir seçenek olabilir Bu yazımızda, klinik ve laboratuvar özellikler nedeniyle ilkolarak SAT tanısıyla takip ettiğimiz, ancak daha sonra medikal tedaviye yanıtsızlık nedeniyle ağrılıHT olabileceğini düşündüğümüz ve cerrahi önerdiğimiz, patoloji sonucu HT ve mikropapiller tiroidkarsinomu ile uyumlu olan nadir bir olguyu sunmayı amaçladık.ABSTRACTChronic lymphocytic thyroiditis, or Hashimoto’s thyroiditis (HT) is an inflammatory thyroid diseasewhich is the most common cause of goiter and acquired hypothyroidism in iodine sufficient areasthat autoimmunity, genetic predisposition and environmental factors play role in pathogenesis.Thyroid pain and tenderness may rarely be present in HT mimicking subacute granulamatousthyroiditis (SAT). Although SAT is a selflimiting condition, cases with severe symptoms maynecessitate use of steroids. Symptoms reduce in a short time with use of steroids in SAT. Higherand repeated doses of steroids may be rarely necessary in some cases after stopping steroids. Incontrary to SAT, patients with painful HT have only temporary or no response to medical treatmentand/or show repeated relapses. Thyroidectomy may be an option in painful HT cases that do notresponse to treatment.In this article, we aimed to present a rare case of micropapillary thyroid cancer with coexistenceof HT who was suggested surgery after compatible pathology findings which was first followed forthe diagnosis of SAT after clinical and laboratory findings, while it was assumed to be a case withpainful HT because of the unresponsiveness to medical therapy.
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