Subacute granulomatous de Quervain's thyroiditis - Case 15. |
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Clinical presentation: a 41-year-old man was presented with fever and a painful thyroid for a month. He suffered from upper airways infection 3 months before the present examination.
Palpation: both thyroids were hard and painful.
Functional state: hyperthyroidism with TSH-level 0.01 mIU/L, FT4 90.1 pM/L, We 59 mm/H.
Ultrasonography: the right thyroid was echonormal with around 25% hypoechogenic areas, while the left thyroid was moderately hypoechogenic. The vascularization was not specific, minimally decreased.
Cytology: there were only degenerated follicular cells and nuclear debris on the smear. No pathognomic multinucleated giant cells were present.
Final combined clinical-sonographic-cytological diagnosis: subacute, granulomatous de Quervain's thyroiditis.
Suggestion: steroid therapy.
Comment: the cytological pattern is almost diagnostic itself. Such degenerated cells and nuclear debris without the predominance of lymphoid cells is specific for de Quervain's thyroiditis.