A case of acute exacerbation of Hashimoto's thyroiditis with a nontender thyroid

We report a 54-year-old female with high grade fever, fatigue, and painless swelling of the thyroid gland. Based on findings of high gallium-67 citrate uptake in an enlarged thyroid gland accompanied by severe systemic inflammation including an increase in various cytokines and histology of biopsied specimens indicating typical chronic thyroiditis, a diagnosis of acute exacerbation of Hashimoto's thyroiditis was made. All clinical symptoms were relieved by oral naproxen following a prolonged hypothyroid status. This may be the first case report describing painless acute exacerbation of Hashimoto's thyroiditis, and may provide insight into the clinical spectrum of acute inflammatory reactions in Hashimoto's thyroiditis.