Painful Hashimoto's thyroiditis: myth or reality?
Neck pain is a common complain, being in most cases due to non-thyroidal causes. However, a minority of patients suffer from painful thyroid diseases. Among them, sub-acute thyroiditis (SAT) is the most frequent one. Rare thyroid-related causes of neck pain include hemorrhage within a thyroid nodule as well as Riedel's thyroiditis and suppurative thyroiditis. In the last 30 years, a few cases of a painful variant of Hashimoto's thyroiditis (HT) have been described. Biochemical, ultrasound, and histologic features were clearly suggestive for HT in all of the published cases and definitely ruled out the diagnosis of SAT. While sound descriptions of painful HT are present in the literature, it is important to emphasize that only 20 cases were reported from the year 2000 until now. The condition, however, is clinically relevant because neck pain was reported to be refractory both to steroids and to other analgesic drugs, being thyroidectomy the only effective treatment for pain relief in these patients. This short review analyzes currently available data supporting a role for HT as a rare cause of neck pain.
Unit of Internal Medicine and Endocrinology, ICS Maugeri I.R.C.C.S., Chair of Endocrinology, University of Pavia, Via S. Maugeri 10, 27100, Pavia, Italy.
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Rotondi
Unit of Internal Medicine and Endocrinology, ICS Maugeri I.R.C.C.S., Chair of Endocrinology, University of Pavia, Via S. Maugeri 10, 27100, Pavia, Italy.|Experimental Medicine, University of Pavia, Pavia, Italy.
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Capelli
Università Cattolica, Institute of Endocrinology, 00168, Rome, Italy.
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Locantore
Università Cattolica, Institute of Endocrinology, 00168, Rome, Italy.
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Pontecorvi
Unit of Internal Medicine and Endocrinology, ICS Maugeri I.R.C.C.S., Chair of Endocrinology, University of Pavia, Via S. Maugeri 10, 27100, Pavia, Italy. luca.chiovato@icsmaugeri.it.
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Chiovato
D050031:Hashimoto Disease / Q000150:complications*; D006801:Humans; D019547:Neck Pain / Q000209:etiology*
Hashimoto thyroiditis; Sub-acute thyroiditis; Thyroid pain