A 34-year-old woman develops fever and severe pain in the anterior neck two weeks after an upper respiratory infection. The thyroid is firm and exquisitely tender. TSH is suppressed, free T4 is mildly elevated, ESR is 68 mm/hr, and radioactive iodine uptake at 24 hours is less than 2%. The most likely diagnosis is:

• A Graves disease
• B Riedel thyroiditis
• C Hashimoto thyroiditis in the hyperthyroid phase
• D Subacute granulomatous (de Quervain) thyroiditis ✓

Explanation

Post-viral painful thyromegaly with a high ESR and markedly suppressed radioiodine uptake is classic for de Quervain thyroiditis. The low uptake reflects destructive release of preformed hormone, which also kills Graves as a distractor, since Graves shows diffusely increased uptake. Histologically it shows granulomas with multinucleate giant cells surrounding colloid. The course is self-limited with a transient hypothyroid phase before recovery.

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.