Painful Hashimoto's thyroiditis: myth or reality?

Area of Science:

• Endocrinology
• Thyroidology
• Pain Management

Background:

• Neck pain commonly arises from non-thyroidal sources.
• Thyroid diseases can cause neck pain, with sub-acute thyroiditis (SAT) being most frequent.
• Rare causes include thyroidal hemorrhage, Riedel's thyroiditis, and suppurative thyroiditis.

Purpose of the Study:

• To review current data on Hashimoto's thyroiditis (HT) as a cause of neck pain.
• To highlight the clinical relevance of painful HT, despite its rarity.

Main Methods:

• Literature review of reported cases of painful Hashimoto's thyroiditis.
• Analysis of biochemical, ultrasound, and histologic features differentiating HT from SAT.
• Evaluation of treatment outcomes for refractory neck pain.

Main Results:

• A painful variant of Hashimoto's thyroiditis (HT) is a rare but clinically significant cause of neck pain.
• Reported cases (20 since 2000) show features distinct from sub-acute thyroiditis (SAT).
• Neck pain in HT is often refractory to standard treatments, with thyroidectomy being the only effective option.

Conclusions:

• Hashimoto's thyroiditis (HT) is a rare but important consideration for unexplained neck pain.
• Distinguishing painful HT from SAT is crucial for appropriate management.
• Thyroidectomy may be necessary for intractable pain associated with HT.