A Case of Painful Hashimoto's Thyroiditis Successfully Treated with Total Thyroidectomy

Painful Hashimoto’s thyroiditis (HT) is a subtype of HT characterized by thyroid pain with overt elevation in inflammatory markers and thyroid autoantibodies. The differential diagnosis of painful HT with subacute granulomatous thyroiditis is often difficult because initial clinical findings are very similar. Findings that favor the diagnosis of painful HT include preceding history of chroni c goiter or autoimmune thyroid diseases, a high titer of thyroid autoantibodies, and repeated painful attacks even with chronic glucocorticoid therapy. Surgery is often needed to relieve the thyroid pain. We report a case of painful HT who received only temporary relief from steroid therapy and required total thyroidectomy for relapsing thyroid pain. The clinical response s to steroid and surgical therapy are described, with a literature review emphasizing the differential diagnosis with subacute granulomatous thyroiditis. To our knowledge, this is the first case report of painful HT treated with total thyroidectomy in the Korean literature.