A 36-year-old woman develops severe anterior neck pain radiating to the jaw, fever, and palpitations three weeks after a viral upper respiratory illness. The thyroid is firm and exquisitely tender. TSH is suppressed, free T4 is elevated, ESR is 82 mm/h, and radioactive iodine uptake at 24 hours is 1%. What is the most likely diagnosis?

• A Graves' disease
• B Toxic multinodular goitre
• C Painless (silent) lymphocytic thyroiditis
• D Subacute granulomatous (de Quervain) thyroiditis ✓

Explanation

Painful goitre, raised ESR, thyrotoxicosis with near absent iodine uptake following a viral prodrome is classic for de Quervain thyroiditis, where follicular destruction releases preformed hormone rather than increasing synthesis. Graves shows diffuse high uptake, toxic nodular goitre shows focal hot areas, and painless lymphocytic thyroiditis mimics the biochemistry but lacks neck pain and a high ESR. Antithyroid drugs are useless here since synthesis is already suppressed.

Reference: Williams Textbook of Endocrinology, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.