Riedel's thyroiditis (RT) is a rare chronic inflammatory disease of the thyroid gland. It is characterized by a fibroinflammatory process that partially destroys the gland and extends into adjacent neck structures. Its clinical manifestation can mask an accompanying thyroid neoplasm and can mimic invasive thyroid carcinoma. Therefore, diagnosis can be difficult prior to surgical removal of the thyroid, and histopathologic examination of the thyroid is necessary for a definite diagnosis. The concurrent presence of RT and other thyroid diseases has been reported. However, to our knowledge, the association of RT with acute suppurative thyroiditis and micropapillary carcinoma has not been reported. We report a rare case of concurrent RT, acute suppurative thyroiditis, and micropapillary carcinoma in a 48-year-old patient.
Anti-Bacterial Agents/therapeutic use ; Biopsy ; Carcinoma/*complications/diagnosis/therapy ; Female ; Hashimoto Disease/*complications/diagnosis/therapy ; Hormone Replacement Therapy ; Humans ; Lymph Node Excision ; Middle Aged ; Thyroid Neoplasms/*complications/diagnosis/therapy ; Thyroidectomy ; Thyroiditis/*complications/diagnosis/therapy ; Thyroiditis, Suppurative/*complications/diagnosis/therapy ; Thyroxine/therapeutic use ; Tomography, X-Ray Computed ; Treatment Outcome

We describe herein an unusual case of subacute thyroiditis presenting as acute psychosis. An 18-year-old male presented at the emergency department due to abnormal behavior, psychomotor agitation, sexual hyperactivity, and a paranoid mental state. Laboratory findings included an erythrocyte sedimentation rate of 36 mm/hr (normal range, 0 to 9), free T4 of 100.0 pmol/L (normal range, 11.5 to 22.7), and thyroid stimulating hormone of 0.018 mU/L (normal range, 0.35 to 5.5). A technetium-99m pertechnetate scan revealed homogeneously reduced activity in the thyroid gland. These results were compatible with subacute thyroiditis, and symptomatic conservative management was initiated. The patient's behavioral abnormalities and painful neck swelling gradually resolved and his thyroid function steadily recovered. Although a primary psychotic disorder should be strongly considered in the differential diagnosis, patients with an abrupt and unusual onset of psychotic symptoms should be screened for thyroid abnormalities. Furthermore, transient thyroiditis should be considered a possible underlying etiology, along with primary hyperthyroidism.
Acute Disease ; Adolescent ; Antipsychotic Agents/therapeutic use ; Humans ; Male ; Psychotic Disorders/diagnosis/drug therapy/*etiology ; Thyroiditis, Subacute/*complications/diagnosis/therapy ; Treatment Outcome

PURPOSE: Acute kidney injury (AKI) caused by hypothyroidism-induced rhabdomyolysis is a rare and potentially life-threatening syndrome. The aim of this study was to investigate the clinical characteristics of such patients. MATERIALS AND METHODS: We retrospectively analyzed five patients treated at the Second Affiliated Hospital of Chongqing Medical University with AKI secondary to hypothyroidism-induced rhabdomyolysis from January 2006 to December 2010. RESULTS: Of the five cases reviewed (4 males, age range of 37 to 62 years), adult primary hypothyroidism was caused by amiodarone (1 case), chronic autoimmune thyroiditis (1 case), and by uncertain etiologies (3 cases). All patients presented with facial and lower extremity edema. Three patients presented with weakness, while two presented with blunted facies and oliguria. Only one patient reported experiencing myalgia and proximal muscle weakness, in addition to fatigue and chills. Creatine kinase, lactate dehydrogenase, and renal function normalized after thyroid hormone replacement, except in two patients who improved through blood purification. CONCLUSION: Hypothyroidism should be considered in patients presenting with renal impairment associated with rhabdomyolysis. Moreover, further investigation into the etiology of the hypothyroidism is warranted.
Acute Kidney Injury/*etiology/therapy ; Adult ; Amiodarone/adverse effects ; Creatine Kinase/blood ; Female ; Humans ; Hypothyroidism/*complications ; Kidney Function Tests ; L-Lactate Dehydrogenase/blood ; Male ; Middle Aged ; Retrospective Studies ; Rhabdomyolysis/diagnosis/*etiology ; Thyroiditis, Autoimmune/complications ; Treatment Outcome ; Vasodilator Agents/adverse effects

Thyrotoxic periodic paralysis (TPP) is a rare manifestation of hyperthyroidism characterized by muscle weakness and hypokalemia. All ethnicities can be affected, but TPP typically presents in men of Asian descent. The most common cause of TPP in thyrotoxicosis is Graves' disease. However, TPP can occur with any form of thyrotoxicosis. Up to our knowledge, very few cases ever reported the relationship between TPP and painless thyroiditis. We herein report a 25-yr-old Korean man who suffered from flaccid paralysis of the lower extremities and numbness of hands. The patient was subsequently diagnosed as having TPP associated with transient thyrotoxicosis due to painless thyroiditis. The paralytic attack did not recur after improving the thyroid function. Therefore, it is necessary that early diagnosis of TPP due to transient thyrotoxicosis is made to administer definite treatment and prevent recurrent paralysis.
Administration, Oral ; Adult ; Anti-Arrhythmia Agents/therapeutic use ; Humans ; Hypokalemic Periodic Paralysis/*diagnosis/drug therapy/etiology ; Male ; Organotechnetium Compounds/chemistry/diagnostic use ; Potassium Chloride/therapeutic use ; Propranolol/therapeutic use ; Radiopharmaceuticals/diagnostic use ; Thyroiditis/*complications/radiography/ultrasonography ; Thyrotoxicosis/*diagnosis/etiology