Chronic lymphocytic thyroiditis - Case 29

Clinical presentation: neck dyscomfort and fever lasting for 3 weeks.
Laboratory data: mild hyperthyroidism with TSH 0.05 mIU/L, FT4 30.1 pM/L, FT3 8.99 pM/L, aTPO 2 U/mL, TSAb negative, erythrocyte sedimentation rate 31 mm/H, CRP 8,9 mg/l (normal values: 0-4.8).

The cytological pattern is consistent with de Quervain's thyroiditis. Two multinucleated giant cells are presented, both of them are composed of epitheloid cells.

Right lobe

Left lobe

The sonographic presentation strongly argues against the possibility of de Quervain's thyroiditis. First, there is no difference between the two lobes. Second, the hypoechogenic areas have sharp, puzzle-like borders, and third, the vascularization is increased.

Our final diagnosis was Hashimoto's thyroditis and hashitoxicosis. The follow-up results, including the development of severe spontaneous hypothyroidism and the elevation of aTPO level 6 months later, verified this. Nevertheless, we cannot exclude the possibility that the patient had initially a de Quervain's thyroiditis, too.