AĞRILI HASHİMOTO TİROİDİTİ: NADİR BİR OLGU SUNUMU Painful Hashimoto’s Thyroiditis: A Rare Case Report

Year 2016, Volume: 6 Issue: 2, 53 - 57, 19.12.2016

Ziynet Alphan Üç Esra Ademoğlu

Abstract

Kronik lenfositik tiroidit veya Hashimoto tiroiditi (HT) iyot eksikliğinin olmadığı bölgelerde guatr

ve edinilmiş hipotiroidinin en sık nedeni olan, patogenezinde otoimmünite, genetik yatkınlık ve

çevresel faktörlerin rol oynadığı inflamatuvar bir tiroid hastalığıdır. HT’de boyunda nadiren subakut

granulamatöz tiroiditi (SAT) taklit eder şekilde ağrı ve hassasiyet olabilir. SAT genellikle kendi

kendini sınırlayan bir durum olmasına rağmen semptomların şiddetli olduğu olgular streroid kullanımını

gerektirebilir. SAT’da steroid kullanımı ile birlikte semptomlar kısa sürede azalır. Steroid

tedavisi kesildikten sonra daha yüksek dozlarda tekrarlarlayan steroid tedavisi bazı olgularda nadiren

gerekebilir. Ağrılı HT’de SAT’ın aksine, medikal tedaviye cevap ya geçicidir ya da yoktur ve/

veya tekrarlayan relapslar görülür. Ağrılı HT olgularında medikal tedaviye yanıt alınamadığı durumlarda

tiroidektomi bir seçenek olabilir Bu yazımızda, klinik ve laboratuvar özellikler nedeniyle ilk

olarak SAT tanısıyla takip ettiğimiz, ancak daha sonra medikal tedaviye yanıtsızlık nedeniyle ağrılı

HT olabileceğini düşündüğümüz ve cerrahi önerdiğimiz, patoloji sonucu HT ve mikropapiller tiroid

karsinomu ile uyumlu olan nadir bir olguyu sunmayı amaçladık.

ABSTRACT

Chronic lymphocytic thyroiditis, or Hashimoto’s thyroiditis (HT) is an inflammatory thyroid disease

which is the most common cause of goiter and acquired hypothyroidism in iodine sufficient areas

that autoimmunity, genetic predisposition and environmental factors play role in pathogenesis.

Thyroid pain and tenderness may rarely be present in HT mimicking subacute granulamatous

thyroiditis (SAT). Although SAT is a selflimiting condition, cases with severe symptoms may

necessitate use of steroids. Symptoms reduce in a short time with use of steroids in SAT. Higher

and repeated doses of steroids may be rarely necessary in some cases after stopping steroids. In

contrary to SAT, patients with painful HT have only temporary or no response to medical treatment

and/or show repeated relapses. Thyroidectomy may be an option in painful HT cases that do not

response to treatment.

In this article, we aimed to present a rare case of micropapillary thyroid cancer with coexistence

of HT who was suggested surgery after compatible pathology findings which was first followed for

the diagnosis of SAT after clinical and laboratory findings, while it was assumed to be a case with

painful HT because of the unresponsiveness to medical therapy.

Keywords

Subakut granulamatöz tiroidit; Boyun ağrısı; Hashimoto tiroiditi

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