A 28-year-old woman develops fever, anterior neck pain radiating to the jaw, and palpitations two weeks after an upper respiratory infection. The thyroid is exquisitely tender, ESR is markedly raised, serum T4 is elevated, and radioactive iodine uptake is less than 2%. Histology would most likely show:

• A Storiform fibrosis with IgG4-positive plasma cells
• B Dense lymphoid infiltrate with germinal centers and Hurthle cells
• C Noncaseating granulomas with multinucleate giant cells surrounding colloid ✓
• D Tall columnar follicular cells with scalloped colloid

Explanation

Subacute (de Quervain) granulomatous thyroiditis follows a viral illness, presents with a painful tender goiter, high ESR, thyrotoxicosis with suppressed radioiodine uptake, and histology showing granulomas with multinucleate giant cells engulfing colloid. The low iodine uptake distinguishes it from Graves disease, where uptake is high. Lymphoid infiltrates indicate Hashimoto thyroiditis, storiform fibrosis indicates Riedel thyroiditis, and scalloped colloid indicates Graves disease.

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.