Sustained fever resolved promptly after total thyroidectomy due to huge Hashimoto’s fibrous thyroiditis

Abstract

We encountered a 55-year-old female patient with Hashimoto's thyroiditis who showed persistent fever, and could not find any source of fever other than the large nontender goiter. Her fever continued with positive CRP for 6 months. Although we did not assume that the inflammation was related to Hashimoto's thyroiditis, total thyroidectomy was performed for cosmetic reasons; however, fever was resolved immediately after thyroidectomy. Pathological diagnosis was Hashimoto's chronic thyroiditis. Immunohistochemical staining showed that the follicular cells were positive for IL-1alpha, IL-1beta, and TNF-alpha. We believed that fever was induced by inflammatory cytokines produced in thyroid. The case indicated that Hashimoto's thyroiditis with nontender goiter could cause idiopathic fever.

What should Autoimmune Thyroiditis be considered for?

“…7 Kubota et al suggested that inflammation disappearing by thyroid surgery indicates that the inflammatory cytokine production originated only from the thyroid; they also elucidated that by positive interleukin (IL)1α, IL1β and tumor necrosis factor (TNF) α staining. 8 Our case is similar to the cases reported in the past. 6,7,9,10 We performed total thyroidectomy and treated postoperative temporary hypocalcemia with calcium and vitamin D supplementation.…”

“…7 Nontender Hashimoto's thyroiditis rarely leads to systemic inflammation, but some patients have persistent fever and benefit from treatment with thyroid surgery. [6][7][8] Histopathological findings include extensive fibrosis and destruction of the thyroid anatomy. 7 Kubota et al suggested that inflammation disappearing by thyroid surgery indicates that the inflammatory cytokine production originated only from the thyroid; they also elucidated that by positive interleukin (IL)1α, IL1β and tumor necrosis factor (TNF) α staining.…”

“…Indications for thyroidectomy in patients with Hashimoto's thyroiditis are limited to the development of lymphoma, severe compression symptoms, enlargement of thyroid struma and repeated episodes of pain. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Most studies have indicated that indications for operation are excessive enlargement of the thyroid (>100 gm), severe symptoms (compression, dysphasia) and malignancy. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] Overall thyroidectomy is only necessary in a small number of patients with Hashimoto diseases, but in some cases, surgical intervention is necessary and helpful.…”