Pathology of De Quervain's Subacute Thyroiditis

Dr Sampurna Roy MD

Pain, swelling, a raised ESR and occasional hyperthyroidism characterize the condition.

Histologically, there is granulomatous thyroiditis with neutrophil polymorph infiltration.

The origin of the multinucleate giant cells is debated with controversy on whether they are histiocytic or derived from the follicular epithelium. 

Areas of thyroid affected by the disease show intrafollicular cellular infiltration, with partial or complete loss of colloid from infiltrated follicles, partial or complete disruption of their lining epithelium, and abnormalities of the basement membrane.

These changes tend eventually to lead to replacement of the damaged follicle by a granuloma-like structure devoid of colloid content and without a recognizable epithelial lining.

The disease also causes interfollicular fibrosis and an interstitial inflammatory cell reaction.    

The histological pattern is typically multiform. 

Formative follicle lesions present a striking appearance, aiding recognition of the disease.

Some follicles contain numerous giant cells, often grouped around a central pool of residual colloid.

Others may contain a considerable proportion of neutrophil polymorphs or show  radially aligned spindle-shaped cells.

The differential diagnosis includes palpation thyroiditis, which is characterized by focal giant cells only, and sarcoidal, tuberculous, fungal and syphilitic thyroiditis.

Further reading