Subacute thyroiditis presenting with creeping in a 6-year-old boy

Area of Science:

• Pediatric Endocrinology
• Radiology

Background:

• Subacute thyroiditis (SAT) is uncommon in pediatric populations, with limited understanding of its clinical presentation in children.
• Acute suppurative thyroiditis (AST) is a more frequent cause of acute thyroid inflammation in pediatric patients.

Observation:

• A 6-year-old boy presented with fever and neck pain, initially suspected as AST.
• Thyroid ultrasonography revealed a hypoechoic region corresponding to tenderness, which subsequently shifted to the isthmus.
• This migratory pattern of hypoechogenicity is characteristic of "creeping thyroiditis."

Findings:

• The patient was diagnosed with creeping thyroiditis, a subtype of SAT, based on the migratory hypoechoic changes on ultrasonography and laboratory parameters.
• The patient showed clinical improvement without anti-inflammatory medication.
• A two-year follow-up confirmed no recurrence of thyrotoxicosis or other thyroid dysfunction.

Implications:

• Ultrasonography findings, particularly the migratory nature of hypoechogenicity indicative of creeping thyroiditis, are crucial for diagnosing SAT in pediatric patients.
• Recognizing creeping thyroiditis aids in differentiating SAT from more common conditions like AST in children.
• This case highlights the importance of characteristic imaging findings in diagnosing rare pediatric thyroid conditions.