Clinical data: a 27-year-old woman was referred for an evaluation of neck pain, subfebrility and elevated sedimentation rate. These complaints lasted for 3 weeks.

Palpation: both thyroids were tender on palpation. The consistency of the thyroids were normal.

Functional state: euthyroidism (TSH 2.07 mIU/L, FT4 12.9 pM/L), erythrocyte sedimentation rate 61 mm/H, CRP: 8.9 mg/L (normal value 0-4.8).

Ultrasonography: the basic echo structure of the thyroid was echonormal with patchy hypoechogenic areas. The echogenicity index was around 20%. The vascularization was increased.

Cytology was performed from a hypoechogenic area and resulted in Hashimoto's thyroiditis.

Auxiliary test: aTPO resulted in 749 U/mL.

Non-steroid anti-inflammatory drug was administered.

3 months later the biochemical and sonographic status of the patient remained unchanged except for the sedimentation rate and CRP which became normal. The patient's complaints were resolved.

Comments:

1. The clinical and sonographic picture were consistent with lymphocytic thyroiditis, but the elevated sedimentation rate and CRP level were unusual. The FNAC was performed in order to exclude the possibility of de Quervain's thyroiditis.

2. The ratio of lymphocytes to follicular cells was very low in this case.