A 32-year-old woman develops anterior neck pain radiating to the jaw two weeks after a febrile upper respiratory illness. The thyroid is diffusely tender. Serum TSH is suppressed with elevated free T4, and radioiodine uptake is nearly absent. Aspirate cytology would most likely show:

• A Lymphocytic infiltrate with Hürthle cell metaplasia
• B Multinucleate giant cells surrounding collapsed follicles and colloid ✓
• C Spindled stromal cells with dense keloidal collagen obliterating thyroid parenchyma
• D Ground-glass nuclei with intranuclear pseudoinclusions

Explanation

This is subacute (granulomatous, de Quervain) thyroiditis, which follows a viral illness, causes a painful tender goiter, produces a thyrotoxic phase with suppressed TSH, and characteristically shows low radioiodine uptake because damaged follicles release preformed hormone. Histology shows granulomatous inflammation with multinucleate giant cells engulfing colloid. Option A is Hashimoto thyroiditis, which is painless with normal or high uptake in the early phase, and option C describes Riedel thyroiditis.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.