A 32-year-old woman develops anterior neck pain radiating to the jaw two weeks after a viral upper respiratory infection. The thyroid is exquisitely tender, TSH is suppressed, free T4 is mildly raised, and radioactive iodine uptake is less than 2%. Histology would most likely show:

• A Granulomatous inflammation with multinucleate giant cells around colloid ✓
• B Lymphoid germinal centers and Hürthle cells
• C Dense keloid-like fibrosis extending into neck soft tissues
• D Follicles filled with papillary projections and psammoma bodies

Explanation

The combination of post-viral onset, tender thyroid, transient thyrotoxicosis with suppressed radioiodine uptake identifies subacute (de Quervain) granulomatous thyroiditis. Histology shows noncaseating granulomas with multinucleate giant cells engulfing colloid, followed by patchy chronic inflammation. Low uptake distinguishes it from Graves disease, where uptake is diffusely increased. Fibrosing disease describes Riedel thyroiditis, which presents as a painless hard goiter.

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.