A 28-year-old woman develops anterior neck pain and fever two weeks after an upper respiratory infection. The thyroid is tender and enlarged. Serum T4 is elevated, TSH is suppressed, and radioactive iodine uptake at 24 hours is less than 2 percent. Histology would most likely show:

• A Non-caseating granulomas with multinucleate giant cells surrounding colloid ✓
• B Dense lymphoplasmacytic infiltrate with germinal centers and fibrosis
• C Storiform fibrosis with obliterative phlebitis and IgG4 plasma cells
• D Follicles distended with pale scalloped colloid and papillary infoldings

Explanation

Painful thyroid after a viral illness with high serum hormones but near-zero radioiodine uptake indicates subacute granulomatous (De Quervain) thyroiditis: released preformed hormone suppresses TSH, so the gland cannot trap iodine. Histology shows granulomatous inflammation with giant cells clustered around colloid. Option B describes Hashimoto thyroiditis, option C describes Riedel/IgG4-related thyroiditis, and option D describes Graves disease, all of which have elevated or normal uptake rather than suppressed uptake.

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.