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Subacute (de Quervain’s) thyroiditis

Case contributed by Andrew Ryan
Diagnosis certain

Presentation

Present with anterior neck pain and odynophagia.

Patient Data

Age: 50
Gender: Male

Ultrasound

ultrasound

Ultrasound of the right lobe of the thyroid demonstrates an ill-defined irregular region of heterogeneous hypoechogenicity without elevation of flow on color Doppler examination. 

Images courtesy of Dr Anthony Upton.

FNA right thyroid lobe

pathology

The FNA smears show an inflammatory process with features consistent with subacute (de Quervain's) thyroiditis:

  • scattered benign reactive follicular epithelial cells
  • prominent inflammatory background including multinucleate giant cells
  • clusters of epithelioid histiocytes, consistent with granulomatous inflammation

Multinucleate giant cells and granulomas can be difficult to differentiate morphologically (see third image) but should not be confused theoretically:

  • multinucleate giant cells are single cells with multiple nuclei, formed by the fusion of numerous macrophages (histiocytes)
  • granulomas are aggregates of numerous 'epitheloid histiocytes' (activated macrophages).

Case Discussion

This case illustrates imaging and cytological features consistent with subacute granulomatous thyroiditis.

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