Endocrine Pathology Case Studies


CASE 8: Subacute Granulomatous Thyroiditis (DeQuervain Disease)


Clinical History:

An previously healthy 40-year-old woman presented to her physician with a 2 week history of pain in her neck. On physical examination she has an enlarged, nodular, firm, tender thyroid. Laboratory studies show her serum T4 is 6.9 microgram/dL. No thyroid peroxidase antibodies are detectable. A thyroid scan shows decreased I131 uptake. There was a clinical suspicion of carcinoma, so the thyroid was removed.
  1. What is the diagnosis?

    2. This is subacute granulomatous thyroiditis (DeQuervain thyroiditis). There is an inflammatory process infiltrating into and causing destruction of the thyroid parenchyma at low and medium power magnification (images 8.1 and 8.2). At higher magnification (images 8.3 and 8.4), there are very large multinucleated giant cells along with inflammatory cell infiltrates that include many neutrophils. There is destruction of the thryoid follicles by this inflammatory reaction.

  2. What is the etiology?

    3. It is thought to be caused by viral infection.

  3. How do these patients usually present?

    4. They usually have fever, neck pain, and an enlarged tender thyroid, but in some cases, as in this one, such a history may not be present and the enlarged, firm thyroid misinterpreted as carcinoma.

  4. Who gets this disease?

    5. Middle aged women are most likely to be affected by this uncommon disease. In fact, all of the thyroid diseases have a female predominance.

  5. What is the typical clinical course for these patients?

    6. The natural history of this disease is that mild hyperthyroidism will progress to transient hypothyroidism and then eventually return to a euthyroid state over weeks to months.