Case Report

Surgical Treatment for Unexplained Severe Pain of the Thyroid Gland: Report of Three Cases and Concise Review of the Literature

Table 1

Characteristics of fifteen patients with painful Hashimoto’s thyroiditis who underwent thyroidectomy.

AuthorsNo.Age/sexSymptomsESR (mm/h)CRP (mg/dL)TT4 (μg/dL)FT4 (ng/dL)TT3 (ng/dL)TSH (mU/L)24-h RAIU (%)MCHA/ TGHA TiterFNA

Normal
range
0–20<0.35–120.8–2.0120–1900.5–6.010–35%0/0
Kon and
DeGroot [6]
136/FDaily neck pain and swelling, 5 months111.38.3NMNM1.523%320/160ND
226/FHT/hypothyroid on L-T4, painful goiter, 1-2 years20ND6.9NMNM9.2
(L-T4 175 μg)
27%20,480/40HT
339/FHT/hypothyroid on L-T4, episodic throat pain radiating to chin and ears, 3 years10<0.312.1NMNM1.46
(L-T4 112 μg)
ND6,400/NDInconclusive
448/FInitially “like SAT”, episodic neck pain, 7 months11–39
(NR 1–39)
<0.35.9NMNM4.6Initial 2%, after 7 months 28%0/0Florid lymphocytic thyroiditis
528/FHT, painful goiter radiating to ears, odynophagia, 1 month11–17ND5.0NM432425%>20,480/10,240HT, giant cells
622/FL-T4 for diffuse goiter, pain right thyroid lobe to right ear, dysphagia, 2 months18ND10.8NMNM0.3
(L-T4 100 μg)
5h 7%, 31 h 17%1,280/40ND
741/FConstant painful goiter on L-T4, especially right side, odynophagia, hoarseness, 5 months16–221.2
(NR 0–1.8)
11NMNM0.8
(L-T4 175 μg)
ND0/0HT, giant cells

Ohye
et al. [7]
124/MFever, neck pain0.63.1NM1.22NM7.72ND409,600/25,600HT
265/FNeck pain51NDNM1.22NMND0.6%102,400/409,600ND
356/FFever, neck pain, swelling66NDNM0.72NM8.7531.9%400/1,638,400HT
462/FFever, neck painND9.0NM1.61NM0.063ND3.3 U/mLa, 13,300 U/mLbND
Gourgiotis
et al. [8]
156/FPrior left hemithyroidectomy for Graves’ disease and HT, episodic neck pain, hoarseness, 4 years19NMNM1.801210.05
(L-T4 150 μg)
ND611 U/mLa, 112 U/mLbHürthle cells, no thyroiditis
232/MNeck pain, swelling, dysphagia, HT, 2 years5NMNM1.703200.60
(L-T4 175 μg)
ND320/100ND

Zimmerman et al. [9]152/FEpisodic neck pain, sore throat, 5 years7NM5.4NMNMNM35%6,400/0Lymphocytic thyroiditis
241/FTender goiter, 6 months16NM4.8NMNMNM23%NDLymphocytic thyroiditis

ND: not determined; NM: not mentioned; NR: normal range; MCHA: antimicrosomal hemagglutination; TGHA: antithyroglobulin hemagglutination; HT: Hashimoto’s thyroiditis; aanti-TPO antibody (normal range, <0.3 U/mL); bantithyroglobulin antibody (normal range, <0.3 U/mL); L-T4: L-thyroxine.