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Atypical thyroiditis in Huelva, Spain.

F L Rueda¹, J M Palomares, I V Rico

¹Department of Endocrinology, Virgen Cinta Center of Specialties, Huelva, Spain.

Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

|July 15, 2004

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An epidemic of atypical thyroiditis affected 672 women in Spain following a severe drought. This painful thyroid condition showed high antibody levels and responded well to levothyroxine and deflazacort treatment, suggesting environmental pollutant exposure.

Area of Science:

Endocrinology
Environmental Medicine
Epidemiology

Background:

An unusual outbreak of atypical thyroiditis occurred in southwestern Europe in 1995.
The epidemic primarily affected women of reproductive age with normal ovarian function.

Purpose of the Study:

To document the clinical, laboratory, and histological features of this atypical thyroiditis epidemic.
To investigate potential etiopathogenetic factors, including environmental influences.

Main Methods:

Clinical, laboratory, morphological, and histological evaluation of 672 thyroiditis cases.
Analysis of thyroid function tests, thyroid antibodies, ultrasonography, and fine-needle aspiration biopsy.
Assessment of treatment outcomes with levothyroxine and deflazacort.

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Main Results:

672 cases of atypical thyroiditis were diagnosed, predominantly in women (98%).
Patients presented with painful, diffuse, nodular thyroid enlargement, normal initial thyroid function tests, and significantly elevated thyroid antibodies.
Ultrasonography revealed diffuse nodular enlargement, and biopsy showed lymphocytic infiltration. Treatment with levothyroxine and deflazacort yielded the best results.

Conclusions:

Atypical autoimmune thyroiditis occurred epidemically following a severe drought.
The condition is characterized by painful thyroid enlargement, elevated antibodies, and a benign course.
Environmental pollutants, potentially estrogen-like substances in tap water due to low water levels, are hypothesized as the cause.