A 30-year-old woman presents with a painful swelling in the lower neck radiating to the jaw and ears, fever, and palpitations. The thyroid is firm and exquisitely tender. ESR is 78 mm/hr, free T4 is elevated, TSH is suppressed, and a radioiodine scan shows virtually absent uptake. What is the most likely diagnosis?

• A Subacute granulomatous (de Quervain) thyroiditis ✓
• B Graves disease
• C Toxic multinodular goitre
• D Riedel thyroiditis

Explanation

Painful tender goitre with fever, markedly raised ESR, thyrotoxicosis from destructive hormone release, and a near-zero radioiodine uptake is classic for de Quervain thyroiditis, usually following a viral illness. In Graves disease and toxic nodular goitre the uptake is normal or increased because the gland is overproducing hormone, not leaking stored hormone. Riedel thyroiditis produces a woody painless mass without thyrotoxicosis or fever. Management is symptomatic with NSAIDs or steroids, not antithyroid drugs.

Reference: Williams Textbook of Endocrinology, 14th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.