Subacute (de Quervain’s) thyroiditis

Case contributed by Dr Andrew Ryan

Presentation

Present with anterior neck pain and odynophagia

Patient Data

Age: 50
Gender: Male

Ultrasound

Modality: Ultrasound

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

Images courtesy of Dr Anthony Upton

FNA right thyroid lobe

Modality: 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 cytology fig 3 above) 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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Case Information

rID: 17052
Case created: 13th Mar 2012
Last edited: 16th Jan 2016
System: Head & Neck
Inclusion in quiz mode: Included

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