Int J Thyroidol.  2017 May;10(1):42-45. 10.11106/ijt.2017.10.1.42.

Atypical Thyroiditis Following Influenza B Infection

• Yu TY
• Lee JH
• Kim HS
• Kim HY
• Cho CG

• KMID: 2379360
• DOI: http://doi.org/10.11106/ijt.2017.10.1.42

Abstract

Viral infections are known to be a predisposing factor for subacute (De Quervain's) thyroiditis. In this report, we document a novel case of thyroiditis, with an atypical presentation, following an influenza B infection. A 13-year-old previously healthy female visited the outpatient clinic complaining of right neck pain. She had been diagnosed with an influenza B infection at a local clinic 3 weeks earlier. All laboratory tests were normal. A thyroid ultrasound showed an ill-defined hypoechoic mass (1.0×0.5×1.5 cm) in the right lower thyroid, and scintigraphy of the thyroid with Technetium-99m (99m-Tc) demonstrated the normal uptake of the radiotracer. Fine-needle aspiration from the nodule showed the presence of a few neutrophils. To the best of our knowledge, this is the first case of atypical thyroiditis associated with an influenza B infection described in the literature. Influenza B infection should be considered as a possible cause of atypical thyroiditis.

Keyword

Influenza B; Infection; Thyroiditis

MeSH Terms

Adolescent
Ambulatory Care Facilities
Biopsy, Fine-Needle
Causality
Female
Humans
Influenza, Human*
Neck Pain
Neutrophils
Radionuclide Imaging
Thyroid Gland*
Thyroiditis*
Ultrasonography

Figure

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  Fig. 1. Initial thyroid ultrasonography and 99m-Technetium scintiscan. (A) Thyroid ultrasonography showed an ill-defined hypoechoic nodule (1.0×0.5×1.5 cm) in the right lobe of the thyroid gland (indicated by white arrows). (B) Thyroid scintigraphy with 99m-Tc revealed normal radiotracer uptake in the thyroid gland.

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  Fig. 2. Follow-up ultrasonography showed resolution of the hypoechoic nodule in the right lobe of the thyroid gland.

Reference

1). Prummel MF, Strieder T, Wiersinga WM. The environment and autoimmune thyroid diseases. Eur J Endocrinol. 2004; 150(5):605–18.

2). Dimos G, Pappas G, Akritidis N. Subacute thyroiditis in the course of novel H1N1 influenza infection. Endocrine. 2010; 37(3):440–1.

3). Cunha BA, Berbari N. Subacute thyroiditis (de Quervain's) due to influenza A: presenting as fever of unknown origin (FUO). Heart Lung. 2013; 42(1):77–8.

4). Michas G, Alevetsovitis G, Andrikou I, Tsimiklis S, Vryonis E. De Quervain thyroiditis in the course of H1N1 influenza infection. Hippokratia. 2014; 18(1):86–7.

5). Altay FA, Guz G, Altay M. Subacute thyroiditis following seasonal influenza vaccination. Hum Vaccin Immunother. 2016; 12(4):1033–4.

6). Pearce EN, Farwell AP, Braverman LE. Thyroiditis. N Engl J Med. 2003; 348(26):2646–55.

7). Sari O, Erbas B, Erbas T. Subacute thyroiditis in a single lobe. Clin Nucl Med. 2001; 26(5):400–1.

8). Singer PA. Thyroiditis. Acute, subacute, and chronic. Med Clin North Am. 1991; 75(1):61–77.

9). Mordes DA, Brachtel EF. Cytopathology of subacute thyroiditis. Diagn Cytopathol. 2012; 40(5):433–4.

10). Vural C, Paksoy N, Gok ND, Yazal K. Subacute granu-lomatous (De Quervain's) thyroiditis: Fine-needle aspiration cytology and ultrasonographic characteristics of 21 cases. Cytojournal. 2015; 12:9.