A Rare Case of Painful Goiter Secondary to Pediatric Hashimoto's Thyroiditis Requiring Thyroidectomy for Pain Control.
Hashimoto's thyroiditis (HT) usually presents as painless thyroid swelling. Painful pediatric HT is a rare condition with limited literature on pain management. We report a 15-year-old female who presented with 4 weeks history of fatigue, malaise and progressive, painful midline thyroid swelling. There was no difficulty in swallowing, no fever or recent upper respiratory infection symptoms. Exam was remarkable for diffusely enlarged, very tender, and non-nodular thyroid. Thyroid function tests, C-reactive protein, and complete blood count were normal. Ultrasound revealed diffusely enlarged non-nodular, non-cystic gland with mild increased vascularity. Diagnosis of HT was confirmed by biopsy and thyroid antibodies. Over a 6 week period, pain management with ibuprofen, levothyroxine, corticosteroid, gabapentin and amitriptyline was unsuccessful. Ultimately, total thyroidectomy resulted in complete resolution of thyroid pain. We can conclude that thyroidectomy may be considered for the rare case of painful HT in children.
Division of Pediatric Endocrinology, Louisiana State University Health Sciences Center , New Orleans, LA, USA.
Liladhar
L
Kashyap
Division of Pediatric Endocrinology, Louisiana State University Health Sciences Center , New Orleans, LA, USA.
Abdulhameed
A
Alsaheel
Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center , New Orleans, LA, USA.
Rohan
R
Walvekar
Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center , New Orleans, LA, USA.
Lawrence
L
Simon
Division of Pediatric Endocrinology, Louisiana State University Health Sciences Center , New Orleans, LA, USA.
Ricardo
R
Gomez
Painful goiter; pain management; pediatric Hashimoto’s thyroiditis