Category: Thyroid

Monitor: 20

20 - A RECURRENT CASE OF SILENT THYROIDITIS

Friday, Apr 26
11:00 AM – 11:30 AM

Objective :

Introduction:
Thyroiditis encompasses a group of disorders characterized by thyroid inflammation and is often associated with a painful thyroid. Silent or painless thyroiditis accounts for approximately 0.5 to 5% of cases of thyrotoxicosis and is usually not recurrent. We report the case of a young female with recurrent silent thyroiditis and complete thyroid function recovery.


Case Report:

A 32 y/o female with a previous episode of thyrotoxicosis 10 years ago which was initially treated with anti-thyroidal therapy for presumed Grave's disease. The therapy was discontinued after 1 month due to prompt resolution of the thyrotoxicosis. She remained asymptomatic and with normal thyroid function studies until presenting with 2 weeks history of fatigue, palpitations, chest tightness, heat intolerance, 10 pounds weight loss and hair loss. She denied neck pain but reported mild swallowing difficulties. Vitals signs were normal except for a heart rate of 102/min.  Physical examination showed a thin woman with a normal sized, firm thyroid gland without nodules or tenderness. 

Laboratory studies: TSH 0.01 (0.36-3.74 mIU/L), free T4 4.01 (0.76-1.46 ng/dL), free T3 >10.0 (2.3-4.2 pg/mL), AST 116 (0-40 IU/L), ALT 305 (0-68 IU/L), TPO <1.00 (0.0-9.0 IU/mL) and TRAB <1.00 (0.0-1.75 IU/L). Thyroid radioiodine uptake was low with an uptake of 0.5%. She was started on propranolol 10 mg TID. The TSH remained suppressed and free T4 and free T3 elevated for 5 weeks. At the time of the patient's 2 months follow up, her TSH was 9.49 with normal free T4 levels and normal liver function test. Patient was without hypothyroid symptoms. TSH returned to normal in 5 months.


Methods : n/a


Results : n/a


Discussion :

Silent thyroiditis is considered a variant form of chronic autoimmune thyroiditis, suggesting that it is part of the spectrum of thyroid autoimmune disorder. The condition is characterized by transient hyperthyroidism, often followed by transient hypothyroidism, and eventual thyroid recovery. Factors described that can initiate silent thyroiditis are: medications (e.g. lithium, immune checkpoint inhibitors, interferon alfa), SLE, idiopathic thrombocytopenia purpura, and others. Silent thyroiditis is self-limited and beta-blockers are used to relieve palpitations in symptomatic patients. This case is unusual in that only 10% of patients experience additional episodes.


Conclusion :

Silent thyroiditis is a rare cause of thyrotoxicosis. Patients affected with this condition can have recurrences in the future, but this is also very rare. Many etiologies have been described in the literature as the presentation of this condition but no precipitating factors were identified in this case.

Leslie Cotto

Endocrine Fellow
Baylor Scott & White
Austin, Texas

I was born and raised in Puerto Rico, to a very humble and hardworking family. My parents always taught me to work hard to archive my dream.

I decided to become a doctor, primary because I was interested of providing the care to my own family members that struggle multiple times trying to afford their medications and even making it to their visit. I went to San Juan Bautista Medical School of medicine in Puerto Rico and while doing all my medical rotations, the interest of becoming an internist grew up on me. The desire to excel at diagnostics and at differentiation is what drove me to the University of Miami to complete my training. My experience at this institution was outstanding, and through my residency I was transformed into a physician who is now extremely confident in her ability to make wise decisions and to offer the best possible medical treatments to her patients.

As a resident, I had the opportunity to participate in hospital medicine as part of my training rotations, where I came into contact with many patients who had been diagnosed with long term diseases such as Diabetes and Hyperthyroidism in the hospital setting and left the hospital without appropriate education regarding their diagnoses. Eventually, they came back to the hospital with the same diagnoses; they had believed they were cured by having taken their medications. While caring for these patients, my interest in Endocrinology developed. I saw how this field would provide me with the necessary tools to provide better treatment options for my patients and, more importantly, reinforce my role as an educator and a physician who uses prevention as one of her treatment goals. Once I completed my internal medicine residency, I joined a program that features outstanding clinical training and exposes the fellow to a wide variety of endocrinology conditions, where I can make a difference using the experience I have gathered during my years of learning and practicing medicine. This program is Baylor Scott & White where I am a second year fellow trainee that is looking forward to graduation day.

Anthony Cryar

Endocrine Attending Physician
Baylor Scott & White
Temple, Texas

Dr. Anthony Cryar is one of my attending physician at Baylor Scott & White Endocrine Fellowship. He has a natural passion for endocrinology and is an amazing physician in diabetes, his favorite topic.

I enjoy expending time with him and learning as much as I can from his knowledge. Not only his fellow enjoys expending time with him in clinic, but his patient cannot say enough good things about him and the care he provide to them.