Thyroid gland
Subacute thyroiditis

Author: Shahidul Islam, M.D., Ph.D. (see Authors page)

Revised: 13 January 2017, last major update March 2009

Copyright: (c) 2003-2017,, Inc.

PubMed Search: subacute thyroiditis
Cite this page: Subacute thyroiditis. website. Accessed March 24th, 2018.
Definition / general
  • Inflammation of thyroid gland that includes granulomas
  • Rare, much less common than Hashimoto's thyroiditis, but most common cause of thyroid pain
  • Painful swallowing (odynophagia), sore throat, thyroid region tenderness, fever, fatigue, malaise
  • Also called de Quervain's thyroiditis or granulomatous thyroiditis
  • Etiology may be systemic viral infection, since associated with epidemics of measles, mumps, Coxsackie, adenovirus and influenza
Clinical features
  • Self limited, usually resolves in 6 - 8 weeks with only 1% having permanent hypothyroidism
  • May be transient hypothyroidism at 2 - 8 weeks
  • High T3 / T4 (initially), elevated sedimentation rate (ESR), suppression of iodine uptake
  • Later hypothyroidism and antithyroid antibodies
  • After weeks to months, patients become euthyroid
Case reports
Gross description
  • Focal to diffuse enlargement of thyroid gland up to 2× normal size
  • May be asymmetric with nodules of variable size; may be firm, but does not adhere to surrounding structures
Microscopic (histologic) description
  • Early: neutrophils and destruction of follicles with colloid depletion
  • Later: noncaseating granulomas surround follicles and engulf colloid
  • Late: fibrosis
Microscopic (histologic) images

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Contributed by Dr. Mark R. Wick

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With fibrosis

Giant cells, inflammatory cells and destruction of thyroid follicles

Giant cells, inflammatory cells and destruction of thyroid follicles

Giant cells, inflammatory cells and destruction of thyroid follicles

Positive Stains:

Cluster of epithelioid cells

Large multinucleate giant cell

Scant epithelioid cells

Multinucleated giant cells

Epithelioid cells and lymphocytes

Virtual slides

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Acute (subacute) nonsuppurative thyroiditis

Measles thyroiditis

Chronic inflammatory infiltrate

Cytology description
  • Cellular smears with clustered epithelioid cells, fibrous fragments with enmeshed inflammatory cells, scattered lymphocytes, histiocytes and neutrophils, occasional multinucleated giant cells containing up to 100 nuclei and ingesting colloid or neutrophils; also occasionally thick colloid with central cracks and frayed edges (Diagn Cytopathol 2006;34:18)
Differential diagnosis
Additional references