1/17. Subacute thyroiditis manifesting as fever of unknown origin.Subacute thyroiditis (SAT) usually occurs in women in middle age with a viral prodrome, thyroid or neck tenderness, classic symptoms of thyrotoxicosis, and elevated erythrocyte sedimentation rate (ESR). We report a case in an 81-year-old man who initially had 2 days of fever to 101.2 degrees F, confusion, and bilateral lower extremity weakness. Extensive evaluation was remarkable only for the following laboratory values: thyrotropin (TSH) 0.02 microIU/mL, free thyroxine (FT4) 3.1 ng/dL, free triiodothyronine (FT3) 6.0 pg/mL, and ESR 98 mm/hr. One week later, the patient had persistent fevers to 102 degrees F; no source was found. The fever resolved, and 3 months later the patient had profound hypothyroidism (TSH >44.0 microIU/mL, FT4 0.4 ng/dL, ESR 13 mm/hr). A painless thyroid gland and atypical manifestations of hyperthyroidism are unusual in SAT. When fever is of unknown origin, SAT should be considered even if classic features are absent.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
2/17. Subacute thyroiditis in a single lobe.A 33-year-old woman with no history of thyroid disease reported pain in her neck and a sore throat. On physical examination, the thyroid gland was palpable. serum T3 and T4 levels were increased, and the thyroid-stimulating hormone level was decreased. Thyroid scintigraphy with Tc-99m pertechnetate revealed nonvisualization of the left lobe of the thyroid. Ultrasonographic examination confirmed the presence of the left thyroid lobe. Fine-needle aspiration biopsy revealed thyroiditis of the left lobe of the thyroid. The patient was started on an anti-inflammatory drug. The follow-up thyroid scan showed a normal thyroid gland.- - - - - - - - - - ranking = 2keywords = gland (Clic here for more details about this article) |
3/17. Fine-needle aspiration of Riedel's disease: report of a case and review of the literature.The cytomorphological features of a case of Riedel's thyroiditis (Riedel's disease) in a 37-yr-old woman are reviewed. The patient presented with a diffusely enlarged thyroid gland with extension to carotid and jugular vessels bilaterally. A fine-needle aspiration of the right lobe of the thyroid demonstrated moderate cellularity with fragments of fibrous tissue with bland spindle-shaped cells and myofibroblasts. The patient subsequently underwent a bilateral subtotal thyroidectomy with removal of two-thirds of both lobes of the thyroid. A frozen section diagnosis of Riedel's disease was later confirmed on paraffin sections. Here we describe the cytological findings of a case of Riedel's disease and provide some helpful clues in distinguishing it from other forms of thyroiditis such as fibrosing variant of Hashimoto's thyroiditis, subacute thyroiditis, or granulomatous thyroiditis and from malignancy with which it can be confused both clinically and cytologically.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
4/17. Ultrasound appearances of de Quervain's thyroiditis.De Quervain's thyroiditis can be readily recognised by ultrasound. The sonographic features and previously unreported signs of two such cases are illustrated. One case had typical multiple hypoechogenic areas in the thyroid parenchyma. The other had multiple small areas giving a spotty appearance not previously reported in de Quervain's. Both patients demonstrated remarkable shrinkage of the gland (to 17.4% and 57% of the original presenting volume). We believe this is a useful diagnostic feature of de Quervain's thyroiditis.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
5/17. Painless giant cell thyroiditis.We describe an atypical case of subacute thyroiditis affecting a 50 year old patient with long lasting fever, weight loss, malaise and a high erythrocyte sedimentation rate. Cytological examination of the thyroid gland showed the classic granulomas with giant cells. However, the patient had neither painful enlargement of the gland nor thyrotoxicosis. This case, as well as others previously described, probably represents a new subtype of subacute thyroiditis, painless giant cell thyroiditis. The presence of painless giant cell thyroiditis should be considered in any patient with undiagnosed pyrexia, weight loss and elevated ESR.- - - - - - - - - - ranking = 2keywords = gland (Clic here for more details about this article) |
6/17. Subacute thyroiditis associated with systemic multi-organ disorders.Subacute thyroiditis is generally thought to be a self-limited inflammatory disease of the thyroid gland. This paper describes serial observations on the clinical course of a typical patient with subacute thyroiditis. This patient showed specific features of destructive thyrotoxicosis with increases in the serum levels of acute phase reactants and in the erythrocyte sedimentation rate. She also showed signs of liver dysfunction [slightly increased alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (gamma-GTP), and leucine aminopeptidase (LAP)], slight anemia, glucose intolerance, increased pancreatic enzymes, splenomegaly, and an increase in peripheral Leu 7 positive (NK/K) cells. These abnormalities all improved with recovery from disease. These findings indicate that in this patient with subacute thyroiditis inflammation is not limited to the thyroid gland but also involves the liver, pancreas and spleen. Thus the subacute thyroiditis in this patient may be a systemic multi-organ disease.- - - - - - - - - - ranking = 2keywords = gland (Clic here for more details about this article) |
7/17. Thyroiditis. Differentiation of acute suppurative and subacute. Case report and review of the literature.Acute suppurative thyroiditis is rarely seen during childhood. The classic clinical features of this illness (fever, neck pain, and a swollen, tender mass over the thyroid gland) can differentiate acute thyroiditis from the more common subacute thyroiditis. In less typical cases, however, this distinction can be difficult. An adolescent male presented with a swollen, tender thyroid gland. Atypical laboratory findings and the lack of fever and toxicity delayed the diagnosis and treatment of acute suppurative thyroiditis. A review of the pediatric literature summarizes clinical and diagnostic features valuable in the differential between acute suppurative thyroiditis and subacute thyroiditis in childhood. The important contribution of fistulae between the piriform sinus and thyroid gland to the pathogenesis and acute suppurative thyroiditis is emphasized. Such a fistula should be sought in every patient in whom this entity is diagnosed.- - - - - - - - - - ranking = 3keywords = gland (Clic here for more details about this article) |
8/17. graves disease presenting as painful thyroiditis.hyperthyroidism associated with subacute (painful, viral) thyroiditis is well-recognized as a clinical entity; the thyroid gland in graves disease is minimally, if ever, tender and painful. We describe a 10-year-old girl with hyperthyroidism whose initial clinical presentation was predominantly a painful, tender goiter. graves disease was established by high uptake of 131I with a diffuse pattern of distribution of radioactivity on scan and the presence of thyroid-stimulating antibody. thyrotropin-binding inhibiting IgG and antibody to thyroid microsomal antigen were both positive. She responded well to treatment with propylthiouracil and had spontaneous regression of her thyroid pain. The cause of the severe pain and tenderness remains speculative.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
9/17. Thyroid amyloidosis with recurrent subacute thyroiditis-like syndrome.We studied 2 men with a subacute thyroiditis-like syndrome (STLS) associated with systemic amyloidosis. Both had very tender, diffuse, firm goiters, low thyroidal radioactive iodine uptake values, and increased erythrocyte sedimentation rates. Glucocorticoid therapy resulted in dramatic improvement. Compared to 18 patients with subacute thyroiditis, these 2 men had 1) persistence of goiter even in remission, 2) repeated exacerbation of STLS, 3) pain always localized in the same site, and 4) gastrointestinal, renal, and cardiac abnormalities. Histological examination of the patients' thyroid glands revealed amyloid deposition and no evidence of subacute thyroiditis. In addition, 1 man had low T3 thyrotoxicosis with an elevated rT3/T3 ratio, suggesting impaired peripheral conversion of T4 to T3, and immunological and histological evidence of Hashimoto's thyroiditis. These findings suggest that thyroid amyloidosis may be associated with STLS. When patients with clinical features of subacute thyroiditis have an unusual course, the possibility of thyroid amyloidosis should be considered.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
10/17. Carcinomatous involvement of the thyroid presenting as subacute thyroiditis.Carcinomatous involvement of the thyroid is a most unusual cause of hyperthyroidism and thyroiditis, with only a few cases reported in the literature. The authors present a 35-year-old woman with signs, symptoms, and laboratory findings of hyperthyroidism, and subacute thyroiditis that was due to extensive replacement of the thyroid gland by adenocarcinoma (shown by fine needle aspiration). After chemotherapy with vincristine and cisplatin, the swelling of the thyroid resolved, thyroidal uptake of radioactive iodine increased, and mild hypothyroidism developed. Despite the improvement in her thyroid status, she died from progressive malignancy. This case illustrates the value of fine needle aspiration cytology where doubt exists in the diagnosis of thyroid disorders.- - - - - - - - - - ranking = 1keywords = gland (Clic here for more details about this article) |
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