Subacute Granulomatous Thyroiditis (de Quervain)

Subacute Granulomatous Thyroiditis (de Quervain)

Lester D. R. Thompson, MD

Multiple follicles are affected by a mixed inflammatory infiltrate, including histiocytes and neutrophils. There is a background of interfollicular fibrosis. This early stage shows the folliculocentric process.

The mixed inflammatory infiltrate shows lymphocytes surrounding a destroyed follicle image, filled with epithelioid histiocytes and multinucleated giant cells image with neutrophils. Fibrosis is also seen.



  • Subacute granulomatous thyroiditis (SGT)


  • Subacute thyroiditis

  • Granulomatous thyroiditis

  • de Quervain thyroiditis

  • Painful subacute thyroiditis

  • Postviral thyroiditis

  • Giant cell thyroiditis

  • Subacute nonsuppurative thyroiditis

  • Pseudotuberculous thyroiditis

  • Struma granulomatosa


  • Self-limited inflammatory condition characterized by epithelioid histiocytes, multinucleated giant cells, and acute inflammatory cells (at certain times in disease development)

    • Requires clinicopathologic correlation with known systemic disease

    • Granulomatous inflammation can be seen in patients with tuberculosis, fungal infections, sarcoidosis



  • Systemic viral infection most common

    • Common prodromal signs and symptoms

    • Intrathyroidal activated T-cytotoxic cells with interferon γ positive lymphocytes

    • Incidence highest in summer months, coincident with enteroviral infections

    • Associated with mumps, influenza, Coxsackie adenovirus, and measles epidemics

    • However, a significant number of patients do not have viral infection

  • Develops after antiviral therapy, specifically interferon


  • Genetic predisposition suggested

    • Increased frequency in patients with HLA-B35 haplotype


  • Possible autoimmune component, as there are thyroid autoantibodies in a few patients



  • Incidence

    • Incidence approximately 5 per 100,000 population per year

    • Suggested seasonal increase in spring and summer

  • Age

    • Wide range

      • Peak: 5th decade

    • Rare in children

  • Gender

    • Female > > Male (3.5:1 )


  • Entire gland usually involved

    • May be localized to 1 lobe or a distinct nodule


  • Prodrome heralds disease

    • Low-grade fever, myalgias, fatigue, sore throat

  • Painful thyroid gland is most common symptom

    • SGT is most common cause of painful thyroid

    • May radiate to jaw

    • Tender to palpation

    • Some patients may not have pain or tenderness

  • Frequently presents with hyperthyroidism

    • Rarely, may present with thyroid storm

  • Become hypothyroid in ensuing weeks to months

  • Spontaneous return to normal function in most patients within 12 months

    • ˜ 7% have persistent hypothyroidism

  • May have other symptoms, including

    • Dysphagia, arthralgia, tremor, excessive sweating, weight loss

Laboratory Tests

  • Thyroid function varies during disease arc

    • Early phase: May be hyperthyroid due to follicle destruction and release of hormone

      • TSH is suppressed; T4 and T3 are elevated

    • Mid phase: Become hypothyroid after follicles are destroyed

    • Late phase: Regain euthyroid after disease resolution

    • Few patients may have transient elevation of antibodies to thyroglobulin or thyroperoxidase

  • C-reactive protein and erythrocyte sedimentation rate are usually elevated

Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Subacute Granulomatous Thyroiditis (de Quervain)
Premium Wordpress Themes by UFO Themes
%d bloggers like this: