title: Painful acute radiation thyroiditis induced by 131I treatment of Graves' disease.
abstract: A 44-year-old woman, chronic smoker with Graves' disease was treated with radioactive iodine ablation (RAI). One week after the treatment, she presented with severe pain in the anterior neck with radiation to the angle of the jaw associated with fatigue, tremor and odynophagia. Physical examination demonstrated an asymmetric and exquisitely tender thyroid gland. There was no laboratory evidence of thyrotoxicosis. Acute radiation thyroiditis was diagnosed. Non-steroidal anti-inflammatory drugs and hydrocodone-acetaminophen started initially were ineffective for pain control. Prednisone provided relief and was continued for 1 month with a tapering dose. Symptoms completely resolved after 1 month at which time the thyroid remained diffusely enlarged and non-tender. Three months following RAI ablation she developed hypothyroid symptoms. Levothyroxine was initiated. The patient has remained asymptomatic on continued follow-up care.
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, VA Nebraska-Western Iowa Healthcare System, Omaha, Nebraska, USA.
authors.forename: Kinjal K
authors.initials: KK
authors.lastname: Shah
authors.affiliation: Division of Endocrinology, Creighton University Medical Center, Omaha, Nebraska, USA.
authors.forename: Valentina
authors.initials: V
authors.lastname: Tarasova
authors.affiliation: Department of Internal Medicine, Creighton University Medical Center, Omaha, Nebraska, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Davidian
authors.affiliation: Section of Endocrinology, Diabetes and Metabolism, VA Nebraska-Western Iowa Healthcare System, Omaha, Nebraska, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Anderson
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D004338:Drug Combinations; D005260:Female; D006111:Graves Disease / Q000532:radiotherapy*; D006801:Humans; D006853:Hydrocodone / Q000627:therapeutic use; D007457:Iodine Radioisotopes / Q000009:adverse effects*; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D011241:Prednisone / Q000627:therapeutic use; D011832:Radiation Injuries / Q000188:drug therapy / Q000209:etiology; D013966:Thyroiditis / Q000209:etiology*
chemical_list: D000701:Analgesics, Opioid; D000893:Anti-Inflammatory Agents; D004338:Drug Combinations; D007457:Iodine Radioisotopes; C083640:acetaminophen, hydrocodone drug combination; D000082:Acetaminophen; D006853:Hydrocodone; D011241:Prednisone