Aug 18, 2016 - Painful thyroid nodule, a misleading presentation of subacute thyroiditis. C. Jonasa, C. .... includes haemorrhagic thyroid nodule, abscess, can-.
Acta Chirurgica Belgica
ISSN: 0001-5458 (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/tacb20
Painful thyroid nodule, a misleading presentation of subacute thyroiditis C. Jonas, C. Bertrand, L. Michel & J. E. Donckier To cite this article: C. Jonas, C. Bertrand, L. Michel & J. E. Donckier (2016): Painful thyroid nodule, a misleading presentation of subacute thyroiditis, Acta Chirurgica Belgica, DOI: 10.1080/00015458.2016.1147262 To link to this article: http://dx.doi.org/10.1080/00015458.2016.1147262
Published online: 18 Aug 2016.
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Date: 01 December 2016, At: 05:11
ACTA CHIRURGICA BELGICA, 2016 http://dx.doi.org/10.1080/00015458.2016.1147262
CASE REPORT
Painful thyroid nodule, a misleading presentation of subacute thyroiditis C. Jonasa, C. Bertrandb, L. Michelb and J. E. Donckiera a
Department of Endocrinology, CHU Dinant-Godinne, Yvoir, Belgium; bDepartment of Surgery, CHU Dinant-Godinne, Yvoir, Belgium
ABSTRACT
KEYWORDS
Typical presentation of subacute thyroiditis (SAT) is an anterior neck pain radiating up to the jaw and ear, often associated with asthenia and fever. Biology shows hyperthyroidism and inflammation. The thyroid uptake is low at scintigraphy. However, the clinical presentation of SAT may be misleading. We report two cases of SAT whose initial manifestation was a painful thyroid nodule suspected of malignancy. In both cases, ultrasound feature was a heterogeneous, hypoechoic, ill-defined area with a low vascularization on colour Doppler. These areas were interpreted by radiologist as nodules. Surgery was then considered. Such a presentation should be known by clinicians to prevent unnecessary surgery.
de Quervain thyroiditis; subacute thyroiditis; thyroid nodule; thyroid ultrasound
Introduction Subacute thyroiditis (SAT) (also called granulomatous, giant cell or de Quervain thyroiditis) is an inflammation of thyroid in response to viral infection of the upper airways occurring from 2 to 6 weeks earlier.[1,2] It preferentially affects women with a ratio F/M of 2:1–6:1.[2] The typical presentation is an anterior cervical pain which may radiate up to the jaw, ear and is often associated with dysphagia, fever and asthenia. Symptoms of hyperthyroidism may be present but often more moderately than in other causes of hyperthyroidism. Laboratory findings include hyperthyroidism, elevated thyroglobulin and inflammation. The ultrasound features are hypoechoic and heterogeneous areas, poorly vascularised on colour Doppler.[3,4] Scintigraphy shows a low thyroid uptake. The natural course is to healing. Treatment with non-steroidal anti-inflammatory or glucocorticoids shortens the course of the disease and reduces symptoms. However, the clinical presentation of SAT can be misleading. We report two cases of SAT whose initial manifestation was a painful thyroid nodule.
heterogeneous nodule measuring 19 19 35 mm with a low flow on colour Doppler (Figure 1). After several consultations, the patient was referred to a surgeon for surgical management of this symptomatic macronodule. Biology showed inflammation (CRP 53 mg/L, NR
