A 28-year-old woman develops fever, a painful enlarged thyroid, and elevated serum thyroxine with suppressed TSH one week after recovery from a viral upper respiratory infection. Radioactive iodine uptake is markedly low. The thyroid biopsy would most likely show:

• A Granulomatous inflammation surrounding colloid with multinucleate giant cells ✓
• B Noncaseating granulomas with Langhans giant cells
• C Dense lymphocytic infiltrate with germinal centers and Huerthle cells
• D Storiform fibrosis obliterating follicles with IgG4-positive plasma cells

Explanation

Painful thyroid enlargement with transient thyrotoxicosis, low radioiodine uptake after a viral illness is classic subacute (de Quervain) granulomatous thyroiditis, believed to be post-viral. Histology shows disrupted follicles with extruded colloid surrounded by epithelioid cells and multinucleate giant cells. Option B describes sarcoidosis, which does not follow viral illness. Low radioiodine uptake distinguishes it from Graves, where uptake is diffusely increased.

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.