Recurrent Silent Thyroiditis: A Report of Four Patients and Review of the Literature
Abstract
Silent thyroiditis, excluding postpartum thyroiditis and destructive amiodarone thyroiditis, is a relatively uncommon cause of thyrotoxicosis and recurrent cases are even rarer. We present four patients with recurrent silent thyroiditis. The number of episodes ranged from two to nine. All four patients had episodes that were similar in duration (4-6 weeks) as well as in their clinical (no viral prodrome or neck pain), biochemical (high total triiodothyronine [T(3)], free thyroxine [T(4)], and low thyrotropin [TSH] presence of antibodies to thyroid antigens), and scintigraphic (low radioiodine uptake) findings. Individual symptoms and symptom-free duration (from 1 to 4 years) were more variable. No associations were found with regard to medications, pregnancies, or other disease states previously implicated in thyroiditis. One patient was unsuccessfully prescribed thyroid hormone to prevent recurrence. Three were treated with radioablative iodine therapy during the recovery phase of an episode; they became hypothyroid and take replacement l-thyroxine. They have remained symptom free.
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Painless thyroiditis is probably an autoimmune disease manifested by positive anti-thyroid peroxidase antibodies in about 50% of patients and findings of lymphocytic infiltration on pathology.
“Painless thyroiditis is probably an autoimmune disease manifested by positive anti-thyroid peroxidase antibodies in about 50% of patients and findings of lymphocytic infiltration on pathology (626,627).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [626]
Recurrence rates for painless thyroiditis are about 5%-10%, but may be higher in Japan, with one Japanese study reporting a long-term recurrence rate of 65%.
“Recurrence rates are about 5%-10%, but may be higher in Japan, with one Japanese study reporting a long-term recurrence rate of 65% (626).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [626]
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- Authors
- Mittra, E. S., & McDougall, I. R.
- Affiliations
- Stanford Medicine (US)
- ORCID
- Mittra, Erik S.
- Venue
- Thyroid
- Publisher
- SAGE Publications
- Published
- 2007-07
- Volume
- 17
- Issue
- 7
- Pages
- 671-675
- ISSN
- 1050-7256 (ISSN-L)
- 1557-9077
- OpenAlex
- W2031948288
- Cited by
- 29
- References
- 29
- Citations by year
- 2022: 2 · 2021: 1 · 2018: 5 · 2016: 3 · 2015: 3 · 2014: 3 · 2013: 1 · 2012: 5
- FWCI
- 0.97
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thyroid (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
- Keywords
- silent thyroiditis, thyrotoxicosis, triiodothyronine, free thyroxine, thyroid autoantibodies, radioiodine uptake, radioiodine ablation, thyroid hormone replacement, hypothyroidism, thyroxine replacement
- MeSH terms
- Adult, Female, Humans, Male, Recurrence, Thyroiditis, Thyroxine, Triiodothyronine
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