Initial examination (first and second rows of images):

Clinical presentation: A 36-year-old woman with a 4-week history of weight loss, fever and neck pain was referred for evaluation. The general practitioner has been administered 20 mg methimazole for 10 days. The complaints of the patients were unchanged.

Palpation: The left lobe was painful and hard.

Laboratory tests: elevated sedimentation rate (71 mm/H) and elevated thyroid hormone levels (TSH undetectable, FT4 39.9 pM/L, FT3 11.4 pM/L).

Ultrasonography: The thyroid was echonormal with around 25% echogenicity index. The left lobe contained hypoechogenic areas with blurred borders. The thyroid was avascular.

Cytological diagnosis: subacute, granulomatous de Quervain's thyroiditis.

Suggestion: steroid therapy and discontinuation of the thyrostatic drug.

Second examination 6 weeks later (third row of images):

Clinical presentation: Within 24 hours of steroid administration, the neck complaints and subfebrility had stopped and did not recur.

Palpation: no abnormality.

Laboratory tests: normal sedimentation rate (11 mm/H) and mild degree of hypothyroidism (TSH 4.08 mIU/L, FT4 6.98 pM/L).

Ultrasonography: The proportion of hypoechogenic areas in the right thyroid has decreased while that in the left lobe has completely disappeared. The vascularization has normalized in the right lobe, while was already decreased in the left thyroid but not absent.