Thyroidectomy for Painful Thyroiditis Resistant to Steroid Treatment: Three New Cases with Review of the Literature

Table 1

Seventy-three patients with painful thyroiditis observed in the years 1996–2013; clinical and laboratory .

Clinical details	Subgroups
Age; years, range, and (median)		14.4–75.2 (42.8)
Sex	Females	58
	Males	15
Systemic symptoms and/or fever	Yes	53
	No	20
Transient thyrotoxicosis	Yes	44
	No	29
TPOAb and/or TgAb levels	Above reference range	19
	Absent and/or within reference range	43
	Unknown	11
TRAb in patients with transient thyrotoxic	Positive	0
	Negative	35
	Unknown	9
Thyroid function in 43 cases with absent or normal TPOAb and TgAb	Transient thyrotoxicosis	28
	Euthyroidism during the observation period	15
Thyroid function in 19 patients with positive TPOAb and/or TgAb	Transient thyrotoxicosis	9
	Euthyroidism during the observation period	6
	Already on treatment with thyroxine for hypothyroidism	3
	euthyroid → Graves’	1
Thyroid nodules at ultrasonography	Yes	22
	No	49
Treatment schedule and	Responders to salicylates or NSAIDs	11
	Responders to	60
	Not responders to steroids (this paper, Cases 2 and 3)	2

Data are expressed in number of subjects when not otherwise specified in the column “clinical details.”
TPOAb: thyroid peroxidase antibodies; TgAb: thyroglobulin antibodies; TRAb: thyrotropin receptor antibodies.
This patient was euthyroid during the painful phase; about three months after the resolution of painful thyroiditis the patient developed persistent thyrotoxicosis with positive TRAb, necessitating treatment with an antithyroid drug.
Before our observation, 18 patients were unsuccessfully treated with antibiotics; steroids were also sometimes used before our observation, but at doses lower than those subsequently found to be effective.
Patients were treated with prednisone 10–40 mg daily (58 cases) or other steroids in equivalent doses (2 cases). After 7–35 days (median 16) a gradual reduction in dosage could be initiated. Remission occurred in 57 patients. During the period of reduction of dosage or after discontinuation a single relapse was observed in 3 cases, all controlled with restoration of higher steroid dosage.