Granulomatous inflammation and multinucleate giant cells around fragmented colloid are histologic features of subacute thyroiditis (de Quervain’s thyroiditis). Subacute thyroiditis typically follows viral illnesses.
Symptoms of subacute thyroiditis include jaw pain, elevated erythrocyte sedimentation rate (ESR), and thyroid tenderness. The disease may manifest as hyperthyroidism early in its course but most often presents as hypothyroidism with findings of general lethargy and fatigue similar to those seen in the above patient. Hypothyroidism in subacute thyroiditis is self-limited and the disease rarely requires treatment.
Bindra et al. review the most common forms of thyroiditis, such as Hashimoto thyroiditis, subacute thyroiditis, and lymphocytic thyroidtis. The authors note that it is important to assess factors such as tenderness, presence of auto-antibodies, and iodide uptake in order to make a proper diagnosis.
Desailloud et al. review the pathogenesis of subacute thyroiditis. The disease is most prevalent in females and is usually characterized by a sudden onset of neck pain and thyrotoxicosis. Subacute thyroiditis is thought to be the result of cytolytic T-cell recognition of viral and cell antigens.
Illustration A demonstrates microscopic findings in subacute thyroiditis. Multinucleate giant cells surround thyroid colloid.
Answer 1: Iodine deficiency predisposes adult patients to Reidel’s thyroiditis, a hypothyroid condition in which fibrous tissue replaces functional thyroid tissue.
Answer 2: Goitrogens (propylthiouracil, sulfadimethoxine) are substances that interfere with iodine uptake and suppress thyroid function. Goitrogens are a risk factor for Reidel’s thyroiditis.
Answer 3: A thyroglossal duct cyst is a fibrous cyst that forms from a persistent thyroglossal duct. It also predisposes patients to Reidel’s thyroiditis.
Answer 5: Chronic renal disease may involve the neck region by causing tertiary hyperparathyroidism in which blood levels of parathyroid hormone and calcium are elevated.
Bindra A, Braunstein GD. Thyroiditis. Am Fam Physician. 2006 May 15;73(10):1769-76
PMID:16734054 (Link to Abstract)
Desailloud R, Hober D. Viruses and thyroiditis: an update. Virol J. 2009 Jan 12;6:5. Review
PMID:19138419 (Link to Abstract)
USMLE World Step 1 QBank Question #768. Copyright © USMLEWorld, LLC 2012