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Patients with silent (painless) thyroiditis may have multiple recurrences
The background of the study. Silent (painless) thyroiditis is characterized by transient hyperthyroidism followed by transient hypothyroidism and then recovery. Multiple episodes are rare. This report describes four patients who had multiple episodes of silent thyroiditis, three of whom were treated with radioiodine to prevent recurrence.
Case 1. This man was 38 years old when he had his first episode of silent thyroiditis in 1979. He subsequently had eight more episodes at approximately three-year intervals. Four months after the last episode, his 24-hour thyroid radioiodine uptake was normal. He was treated with radioiodine and then thyroxine (T4), and has not had another recurrence.
Case 2. This woman had four episodes of silent thyroiditis in eight years. She was treated with T4 for hypothyroidism after her second episode, but later had two more episodes. She therefore was treated with radioiodine during recovery after the last episode in 1992. She became hypothyroid three months later, was treated with T4, and has not had another recurrence.
Case 3. This woman was 27 years old when she had her first episode of silent thyroiditis in 1997, and she had additional episodes in 2000 and 2002. She was treated with radioiodine while hypothyroid during the last episode. She became hypothyroid two months later, was treated with T4, and has not had another recurrence.
Case 4. This man was 24 years old when he had silent thyroiditis in 2002, with transient hyperthyroidism, followed by transient subclinical hypothyroidism. He had a second episode of silent thyroiditis was in 2006.
These four patients had from two to nine episodes, at intervals of one to four years (average, three), of silent thyroiditis, including two episodes during T4 treatment in one patient. The episodes were characterized by transient symptomatic hyperthyroidism, with low 24-hour thyroid radioiodine uptake values at the same time, documenting the diagnosis of thyroiditis. The hyperthyroid phase was followed by transient hypothyroidism, and then normal thyroid function until the next episode. Three patients were ultimately treated with radioiodine to induce hypothyroidism, with the goal of preventing future episodes, which seems to have been successful.
The conclusions of the study. Silent thyroiditis is a cause of transient hyperthyroidism that is often followed by transient hypothyroidism. It occurs sporadically and may be recurrent. Recurrences may be prevented by induction of hypothyroidism with radioiodine.
The original article. Mittra ES, McDougall IR. Recurrent silent thyroiditis: a report of four patients and review of the literature. Thyroid 2007;17:671-5.
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