De Quervain Thyroiditis

Overview
  • de Quervain Thyroiditis, also known as Subacute Granulomatous Thyroiditis, is a self-limited etiology of thyroiditis which is more common in women. The pathogenesis of this disease is poorly understood but is suspected of being due to viral infection consistent with its self-limited clinical course.
Morphology
  • Gross Appearance
    • de Quervain disease may manifest with variable enlargement of neck with the possibility of a visible goiter.
  • Histological Appearance
    • Initially, disruption of thyroid follicles leads to neutrophilic inflammatory infiltrate which is over time replaced by lymphocytes and macrophages. Ultimately, the inflammation subsides with variable remnants of fibrosis.
Clinical Consequences
  • The major distinguishing characteristic of de Quervain thyroiditis is that it is painful, in contrast to Hashimoto's disease which is painless. Acute inflammation of the thyroid gland may result in a transient bout of hyperthyroidism as disrupted follicles release encased thyroid hormones in an unregulated manner. Eventually the hypothyroidism may supervene due to disruption of thyroid gland function. However, resolution of the self-limited inflammation typically leads to full recovery of thyroid gland functionality and thus a return to normalcy within roughly two months.