A painful thyroid gland is unusual in the pediatric population. The differential diagnosis includes acute suppurative thyroiditis, subacute thyroiditis, and the acute phase of chronic thyroiditis. The last is part of the spectrum of autoimmune thyroid diseases and may be associated with transient hyperthyroidism, Graves' disease, or persistent hypothyroidism.1-4 We report a case of a child with the acute phase of chronic thyroiditis who presented with a painful thyroid gland and transient hyperthyroidism, and in whom persistent hypothyroidism developed. Ultimately, features of systemic lupus erythematosus (SLE) developed. This combination in a child has not previously been described.
Patient Report. A previously healthy 9-year-old black prepubertal girl was admitted with a 10-day history of fever and myalgia. There was no family history of thyroid disease. A paternal aunt was being treated for SLE. The patient's pulse rate was 138/min. The only positive finding was a firm and extremely tender