Krysiak Robert, Kobielusz-Gembala Iwona, Okopień Bogusław
Slaski Uniwersytet Medyczny w Katowicach, Klinika Chorób Wewnetrznych i Farmakologii Klinicznej Katedry Farmakologii.
Pol Merkur Lekarski. 2012 Apr;32(190):238-41.
Painful Hashimoto's thyroiditis is an atypical variant of Hashimoto's thyroiditis characterised by thyroid pain and fever. We report the case of a 40-year-old female whose clinical manifestation so closely mimicked subacute thyroiditis that she was initially diagnosed as having de Quervain's disease. Only finding a lymphocytic infiltration in fine needle biopsy specimens of the thyroid gland and positive antithyroid antibodies allowed us to correctly interpret the clinical manifestation of our patient leading to the diagnosis of painful Hashimoto's thyroiditis. No beneficial effect was produced by nonsteroidal antiinflammatory drugs while some improvement was observed after treatment with propranolol. The most effective drug was thiamazole that not only normalised thyroid hormone levels but also caused disappearance of fever and markedly reduced pain intensity. The discussed case shows difficulties in diagnosis of inflammatory processes in the thyroid gland and indicates that antithyroid drugs may be effective agents in hyperthyroid patients with painful Hashimoto's thyroiditis.
疼痛性桥本甲状腺炎是桥本甲状腺炎的一种非典型变体，其特征为甲状腺疼痛和发热。我们报告一例40岁女性病例，其临床表现与亚急性甲状腺炎极为相似，最初被诊断为亚急性甲状腺炎。仅在甲状腺细针穿刺活检标本中发现淋巴细胞浸润以及抗甲状腺抗体呈阳性，才使我们能够正确解读该患者的临床表现，从而诊断为疼痛性桥本甲状腺炎。非甾体类抗炎药未产生有益效果，而使用普萘洛尔治疗后观察到有所改善。最有效的药物是甲巯咪唑，它不仅使甲状腺激素水平恢复正常，还使发热消失，并显著减轻了疼痛强度。所讨论的病例显示了甲状腺炎症过程诊断中的困难，并表明抗甲状腺药物可能是疼痛性桥本甲状腺炎甲亢患者的有效药物。
