A Case Report of Unilateral Development of Painful Thyroiditis Used As a Hallmark of the Nervous Nature of Its Pathogenesis

Overview

Journal AME Case Rep

Publisher AME Publishing Company

Date 2025 Jan 27

PMID 39866277

Authors

Andrey Valerievich Ushakov

Affiliations

Soon will be listed here.

Abstract

Background: Painful thyroiditis (PT) combines several variants of pathology. The most common is subacute thyroiditis (ST). Despite the prevailing view that the factors underlying the development of ST have an infectious origin, its viral and bacterial pathogeneses remain unclear. Moreover, the hypothesis of genetic predisposition to ST is non-absolute. In previous studies, approximately 24-40% patients with ST manifested unilateral thyroid disease; however, the assessment of the pathogenesis of ST did not consider this fact.

Case Description: This case of unilateral PT in a pregnant woman has become an illustrative example for revising the idea of its pathogenesis. Laboratory data did not show obvious signs of inflammation, which is typical for pregnant women and does not exclude ST. At the same time, rare in the literature illustrations of the ultrasound picture of unilateral PT are shown. Pathological parallels with other unilateral thyropathies have been drawn. A possible source of unilateral thyroid changes may be the nerve-conducting mechanism.

Conclusions: The involvement of the nervous system in the inflammatory process and the possibility that unilateral nerve conduction affects only one of the thyroid lobes, as demonstrated in the present case, indicate that the autonomic nervous system (ANS) plays a leading role in PT development.

References

Sencar M, Calapkulu M, Sakiz D, Akhanli P, Hepsen S, Duger H . The contribution of ultrasonographic findings to the prognosis of subacute thyroiditis. Arch Endocrinol Metab. 2020; 64(3):306-311. PMC: 10522218. DOI: 10.20945/2359-3997000000253. View

Gerendai I, Halasz B . Neuroendocrine asymmetry. Front Neuroendocrinol. 1997; 18(3):354-81. DOI: 10.1006/frne.1997.0154. View

Peng C, Chang R, Pennant M, Huang H, Munir K . A Literature Review of Painful Hashimoto Thyroiditis: 70 Published Cases in the Past 70 Years. J Endocr Soc. 2020; 4(2):bvz008. PMC: 7003982. DOI: 10.1210/jendso/bvz008. View

Rotondi M, Capelli V, Locantore P, Pontecorvi A, Chiovato L . Painful Hashimoto's thyroiditis: myth or reality?. J Endocrinol Invest. 2017; 40(8):815-818. DOI: 10.1007/s40618-017-0655-5. View

Ushakov A . Principles and features of ultrasound hypoechogenicity in diffuse thyroid pathology. Quant Imaging Med Surg. 2024; 14(3):2655-2670. PMC: 10963852. DOI: 10.21037/qims-23-1357. View

Stasiak M, Tymoniuk B, Adamczewski Z, Stasiak B, Lewinski A . Sonographic Pattern of Subacute Thyroiditis Is HLA-Dependent. Front Endocrinol (Lausanne). 2019; 10:3. PMC: 6351437. DOI: 10.3389/fendo.2019.00003. View

Bai C, Shen G, Yang Y, Yang K, Hayden M, Zhou Y . Subacute thyroiditis during early pregnancy: a case report and literature review. BMC Pregnancy Childbirth. 2022; 22(1):19. PMC: 8742321. DOI: 10.1186/s12884-021-04368-2. View

Anastasilakis A, Karanicola V, Kourtis A, Makras P, Kampas L, Gerou S . A case report of subacute thyroiditis during pregnancy: difficulties in differential diagnosis and changes in cytokine levels. Gynecol Endocrinol. 2010; 27(6):384-90. DOI: 10.3109/09513590.2010.493963. View

Desailloud R, Hober D . Viruses and thyroiditis: an update. Virol J. 2009; 6:5. PMC: 2654877. DOI: 10.1186/1743-422X-6-5. View

10.

Cappelli C, Pirola I, Gandossi E, Formenti A, Agosti B, Castellano M . Ultrasound findings of subacute thyroiditis: a single institution retrospective review. Acta Radiol. 2013; 55(4):429-33. DOI: 10.1177/0284185113498721. View

11.

Ilicki A, Gamstedt A, Karlsson F . Hyperthyroid Graves' disease without detectable thyrotropin receptor antibodies. J Clin Endocrinol Metab. 1992; 74(5):1090-4. DOI: 10.1210/jcem.74.5.1349025. View

12.

Felicetta J . Painful, painless, and postpartum thyroiditis. Distinct entities or merely variants?. Postgrad Med. 1989; 86(5):269-72, 277. DOI: 10.1080/00325481.1989.11704451. View

13.

Vita R, Lapa D, Trimarchi F, Benvenga S . Stress triggers the onset and the recurrences of hyperthyroidism in patients with Graves' disease. Endocrine. 2014; 48(1):254-63. DOI: 10.1007/s12020-014-0289-8. View

14.

Othman S, Parkes A, Richards C, Hall R, Lazarus J . Post-partum thyroiditis can be painful. Postgrad Med J. 1990; 66(772):130-1. PMC: 2429538. DOI: 10.1136/pgmj.66.772.130. View

15.

Pavlov V, Tracey K . Neural circuitry and immunity. Immunol Res. 2015; 63(1-3):38-57. PMC: 4743890. DOI: 10.1007/s12026-015-8718-1. View

16.

Romeo H, Gonzalez Solveyra C, Vacas M, Rosenstein R, Barontini M, Cardinali D . Origins of the sympathetic projections to rat thyroid and parathyroid glands. J Auton Nerv Syst. 1986; 17(1):63-70. DOI: 10.1016/0165-1838(86)90044-5. View

17.

Manthri R, Ajit N, Vaikakkara S, Devi B, Kalawat T . Unilateral Graves' Disease: The Lesser Known. Indian J Nucl Med. 2019; 34(2):96-98. PMC: 6481210. DOI: 10.4103/ijnm.IJNM_11_19. View

18.

Chen L, Green J . First reported case of unilateral Graves' disease in the left lobe of a bilobar thyroid gland. Thyroid. 2011; 21(6):683-6. DOI: 10.1089/thy.2010.0343. View

19.

Nishihara E, Ohye H, Amino N, Takata K, Arishima T, Kudo T . Clinical characteristics of 852 patients with subacute thyroiditis before treatment. Intern Med. 2008; 47(8):725-9. DOI: 10.2169/internalmedicine.47.0740. View

20.

Tracey K . Reflex control of immunity. Nat Rev Immunol. 2009; 9(6):418-28. PMC: 4535331. DOI: 10.1038/nri2566. View