title: Painless thyroiditis associated to thyroid carcinoma: role of initial ultrasonography evaluation.
abstract: Even though it is a rare event, most associations of thyroid carcinoma with subacute thyroiditis described in the literature are related to its granulomatous form (Quervain's thyroiditis). We present a patient with subacute lymphocytic thyroiditis (painless thyroiditis) and papillary thyroid cancer that was first suspected in an initial ultrasound evaluation. A 30-year old female patient who was referred to the emergency room due to hyperthyroidism symptoms was diagnosed with painless thyroiditis established by physical examination and laboratory findings. With the presence of a palpable painless thyroid nodule an ultrasound was prescribed and the images revealed a suspicious thyroid nodule, microcalcification focus in the heterogeneous thyroid parenquima and cervical lymphadenopathy. Fine needle aspiration biopsy was taken from this nodule; cytology was assessed for compatibility with papillary thyroid carcinoma. Postsurgical pathology evaluation showed a multicentric papillary carcinoma and lymphocytic infiltration. Subacute thyroiditis, regardless of type, may produce transitory ultrasound changes that obscure the coexistence of papillary carcinoma. Due to this, initial thyroid ultrasound evaluation should be delayed until clinical recovery. We recommended a thyroid ultrasound exam for initial evaluation of painless thyroiditis, particularly in patients with palpable thyroid nodule. Further cytological examination is recommended in cases presenting with suspect thyroid nodule and/or non-nodular hypoechoic (> 1 cm) or heterogeneous areas with microcalcification focus.
authors.affiliation: Irmandade da Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil.
authors.forename: Raisa Bressan
authors.initials: RB
authors.lastname: Valentini
authors.affiliation: Irmandade da Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil.
authors.forename: Bruno Mussoi de
authors.initials: BM
authors.lastname: Macedo
authors.affiliation: Irmandade da Santa Casa de Misericórdia de Porto Alegre, UFCSPA, Porto Alegre, RS, Brasil.
authors.forename: Rogério Friedrich
authors.initials: RF
authors.lastname: Izquierdo
authors.affiliation: Irmandade da Santa Casa de Misericórdia de Porto Alegre, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brasil.
authors.forename: Erika Laurini Souza
authors.initials: EL
authors.lastname: Meyer
mesh_terms: D000328:Adult; D044963:Biopsy, Fine-Needle; D002277:Carcinoma / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D015203:Reproducibility of Results; D013961:Thyroid Gland / Q000000981:diagnostic imaging; D016606:Thyroid Nodule / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D013968:Thyroiditis, Subacute / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D014463:Ultrasonography