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

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

Pathology

FNA right thyroid lobe

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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