Endocrine Abstracts

Introduction: De Quervain’s thyroiditis, also known as subacute granulomatous thyroiditis, is a self-limiting inflammatory disorder of the thyroid gland. It is presumed to be caused by a viral infection and many patients have a history of an upper respiratory infection 2-8 weeks prior to the onset of thyroiditis. It is the most common cause for neck pain or discomfort, and it usually has a predictable course of thyroid function evolution. On ultrasonography the thyroid gland might be slightly enlarged or normal with a diffuse or focal hypoechogenic appearance.

Aim (s): We report the case of a 50- year -old female patient referred for the work-up of a TIRADS 5 thyroid nodule with satellite enlarged lymph nodes.

Materials and methods: Anamnesis revealed a progressive onset low anterior neck pain after an upper respiratory infection. On physical examination the thyroid gland was enlarged and tender. Laboratory assessment showed subclinical hyperthyroidism with suppressed TSH (0.05 µUI/ml) and normal levels of FT4 and TT3. Anti- thyroid peroxidase antibodies, anti- thyroglobulin and anti- TSH receptor antibodies were negative. Our patient associated high levels of inflammatory markers: erythrocyte sedimentation rate level was 57 mm/h and C-reactive protein was 24.9 mg/dl. Neck ultrasound identified multiple thyroid nodules with a left dominant nodule of 2.75/1.5/1.5 cm with a high index of sonographic suspicion for thyroid cancer and multiple left lymph nodes.

Results: Thus, the diagnosis of subacute granulomatous thyroiditis was established and treatment with oral corticosteroids was initiated. Thyroid ultrasound-guided fine needle aspiration cytology was performed and the result showed follicular cells without nuclear atypia and several multinucleated giant cells. One month after treatment onset, follow-up ultrasound examination showed complete resolution and disappearance of the thyroid nodules. The patient became hypothyroid and replacement treatment with Levothyroxine was initiated.

Conclusion: De Quervain’s thyroiditis can sometimes show on ultrasound the presence of ill-defined hypoechoic thyroid lesions that may be interpretated as thyroid nodules. Thus, it is important to properly identify these transient lesions to improve the treatment and follow-up of these patients and de Quervain’s thyroiditis should be included in the differential diagnosis of thyroid nodules.