A 29-year-old woman presents one week after a febrile upper respiratory illness with anterior neck pain radiating to the jaw. Free T4 is 3.1 ng/dL, TSH is less than 0.01 mIU/L, ESR is 78 mm/hour, and the thyroid is exquisitely tender. Which finding confirms the underlying pathophysiology of this disorder?

• A Suppressed radioactive iodine uptake with elevated serum thyroglobulin ✓
• B Diffusely increased radioactive iodine uptake at 24 hours
• C Normal radioactive iodine uptake with detectable TSH receptor antibodies
• D Elevated uptake confined to one lobe with a cold nodule on scan

Explanation

Subacute (De Quervain) granulomatous thyroiditis is a post-viral destructive process: follicular rupture releases preformed hormone and thyroglobulin, so serum T4 and T3 rise while the damaged gland cannot trap iodine, giving suppressed radioactive iodine uptake. This dissociation of high hormone with low uptake distinguishes it from Graves disease, where uptake is diffusely increased. Painful presentation with high ESR separates it from painless lymphocytic thyroiditis.

Reference: Williams Textbook of Endocrinology, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.