A 32-year-old woman presents with anterior neck pain radiating to the jaw after a recent upper respiratory infection. TSH is suppressed, free T4 mildly raised, and ESR is 68 mm/hour. The gland is firm and tender. Which finding is expected over the next few months?
- A Permanent hypothyroidism requiring lifelong levothyroxine in most patients
- B Sequential evolution through thyrotoxicosis, hypothyroidism, and recovery of euthyroidism ✓
- C Progressive enlargement into a toxic multinodular goitre
- D Persistence of suppressed TSH indefinitely due to autonomous nodules
Correct answer: B. Sequential evolution through thyrotoxicosis, hypothyroidism, and recovery of euthyroidism
Explanation
Subacute granulomatous (de Quervain) thyroiditis follows a characteristic triphasic course: release of preformed hormone causes transient thyrotoxicosis, followed by a hypothyroid phase lasting weeks to months, and eventual recovery to euthyroidism in over 90 percent of patients. Permanent hypothyroidism is uncommon, which eliminates option A. The combination of painful gland, high ESR, and post-viral onset distinguishes it from painless lymphocytic thyroiditis, which shares the same hormonal phases but lacks neck pain.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.