Acute Thyroid Pain in Pregnancy: Painful Hashimoto's Thyroiditis Versus Subacute Thyroiditis—A Case Report
https://doi.org/10.15605/jafes.041.S1
- Author:
Hamizah Hamzah
1
;
Sarojini Devi Simanchalam
1
;
Wong Poh Shean
1
;
Nor Afidah Karim
1
;
Noor Lita Adam
1
Author Information
1. Endocrine Unit, Medical Department, Hospital Tuanku Ja’afar Seremban
- Publication Type:Journal Article
- MeSH:
Female;
Pregnancy;
Thyroiditis, Subacute
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):104-105
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Painful Hashimoto's thyroiditis is a rare and atypical
form of autoimmune thyroid disease characterized by
thyroid pain and tenderness. It can closely resemble subacute thyroiditis and must be distinguished from other
causes of thyroid pain, including hemorrhage into a
cyst and thyroid abscess. This distinction is particularly
important in pregnancy, where radionuclide imaging is
not recommended.
Case:A 27-year-old pregnant female (G4P3) at 24 weeks’
gestation, with Southeast Asian ovalocytosis and dietcontrolled gestational diabetes, was diagnosed with
primary hypothyroidism at 14 weeks following evaluation
of a painless goiter. Initial tests showed markedly elevated
thyroid-stimulating hormone (>150 mIU/L), low free
thyroxine (3.5 pmol/L), and positive anti-thyroid peroxidase
antibodies (319 IU/mL), consistent with Hashimoto's
thyroiditis. Levothyroxine therapy achieved biochemical
euthyroidism.
At 24 weeks, she developed acute right-sided anterior neck
pain radiating to the ear, with dysphagia, odynophagia,
and fever. Examination revealed a tender thyroid without
lymphadenopathy. Ultrasound demonstrated diffuse
enlargement with bilateral ill-defined hypoechoic avascular
areas. Inflammatory markers showed markedly elevated
C-reactive protein (184 mg/L) with a normal erythrocyte
sedimentation rate (16 mm/h), while thyroid function
remained within target range. Imaging and clinical findings
made abscess and hemorrhage unlikely.
The presence of pre-existing autoimmune thyroid disease,
antibody positivity, and hypothyroidism before symptom
onset supported painful Hashimoto's thyroiditis over subacute thyroiditis. This case highlights that normal thyroid
function tests do not necessarily indicate disease remission,
as inflammatory activity may persist independently of
hormone levels.
Conclusion:Painful Hashimoto's thyroiditis should be considered
in pregnant patients with known autoimmune thyroid
disease presenting with acute thyroid pain despite normal
thyroid function. Diagnosis requires integration of clinical,
biochemical, and imaging findings to guide appropriate
management.
- Full text:2026080417004661494EP_A152.pdf
