Abstract
Even though it is a rare event, most associations of thyroid carcinoma with subacute thyroiditis described in the literature are related to its granulomatous form (Quervain's thyroiditis). We present a patient with subacute lymphocytic thyroiditis (painless thyroiditis) and papillary thyroid cancer that was first suspected in an initial ultrasound evaluation. A 30-year old female patient who was referred to the emergency room due to hyperthyroidism symptoms was diagnosed with painless thyroiditis established by physical examination and laboratory findings. With the presence of a palpable painless thyroid nodule an ultrasound was prescribed and the images revealed a suspicious thyroid nodule, microcalcification focus in the heterogeneous thyroid parenquima and cervical lymphadenopathy. Fine needle aspiration biopsy was taken from this nodule; cytology was assessed for compatibility with papillary thyroid carcinoma. Postsurgical pathology evaluation showed a multicentric papillary carcinoma and lymphocytic infiltration. Subacute thyroiditis, regardless of type, may produce transitory ultrasound changes that obscure the coexistence of papillary carcinoma. Due to this, initial thyroid ultrasound evaluation should be delayed until clinical recovery. We recommended a thyroid ultrasound exam for initial evaluation of painless thyroiditis, particularly in patients with palpable thyroid nodule. Further cytological examination is recommended in cases presenting with suspect thyroid nodule and/or non-nodular hypoechoic (> 1 cm) or heterogeneous areas with microcalcification focus.
Highlights
D estructive thyroiditis is characterized by thyroid inflammation, consequent deregulated release of thyroid hormones secondary to the destruction of the thyroid follicles, and by proteolysis of the stored thyroglobulin [1]
We present a patient with subacute lymphocytic thyroiditis and papillary thyroid cancer first suspected in the ultrasound evaluation during active phase of disease
Subacute lymphocytic thyroiditis is clinically and pathologically similar to postpartum thyroiditis, but it occurs in the absence of pregnancy
Summary
D estructive thyroiditis is characterized by thyroid inflammation, consequent deregulated release of thyroid hormones secondary to the destruction of the thyroid follicles, and by proteolysis of the stored thyroglobulin [1]. Characteristic ultrasound features of SAT, especially granulomatous form, are enlargement of thyroid gland, focal hypoechoic zones with indefinite borders or diffuse hypoechoecogenicity, and lack or low flow on color Doppler in these areas [7]. Though these ultrasound findings are not pathognomic for SAT and the ultrasound appearances may overlap with other types of thyroiditis and some types of thyroid cancer, but the clinical presentation should allow differentiation. Findings in SAT can mimic thyroid carcinoma and marked hypoechoic, ill-defined focal areas may suggest thyroid cancer [10] These ultrasound changes may completely disappear when a re-. We present a patient with subacute lymphocytic thyroiditis (painless thyroiditis) and papillary thyroid cancer first suspected in the ultrasound evaluation during active phase of disease
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