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Musculoskeletal/Small parts » Thyroid, Parathyroid, Salivary Glands
Subacute Granulomatous Thyroiditis, de Quervain's thyroiditis
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Author(s) :
Danilo Sirigu, MD
 
Presentation A 39-year-old man presents with acute onset of pain in the thyroid region, exacerbated by turning the head swallowing.  The pain radiates to the jaw.
 
 
Caption: Video: Thyroid transverse and longitudinal
Description: The transverse and longitudinal thyroid sonograms show ill-defined hypoechoic areas in the periphery of both the right and left lobe.
 
 
Caption: Color Doppler of the Thyroid
Description: Color Doppler ultrasonography shows a marked increase in vascularity predominantly in the hypoechoic areas.
 
 
 
Caption: Color Doppler of the thyroid
Description: Color Doppler ultrasonography shows a marked increase vascularity.
 
Differential Diagnosis De Quervain thyroiditis
Autoimmune Thyroid Disease and Pregnancy
Hashimoto Thyroiditis
Thyroid Lymphoma
Thyroid Nodule
 
Final Diagnosis
Subacute Granulomatous Thyroiditis, de Quervain's thyroiditis
 
Discussion Subacute granulomatous thyroiditis (De Quervain's Thyroiditis ) is a spontaneously remitting inflammatory disease that is probably caused by viral infection. De Quervain's Thyroiditis is the most common cause of a painful thyroid gland.
Ultrasonography demonstrates focal ill-defined hypoechoic areas within the thyroid.  Color Doppler demonstrates more or less increased vascularity especially in the periphery of the gland.  The increased vascularity is most intense in the hypoechoic areas. 
Zacharia et al. reported the utility of color Doppler US in a single case of subacute granulomatous thyroiditis mimicking a thyroid carcinoma. They reported that color Doppler US showed no hypervascularity in the acute stage, and slightly increased vascularity was seen in the recovery stage. In contrast, the case presented here demonstrates a more marked increase in vascularity, particularly in the hypoechoic areas.
Prognosis of subacute thyroiditis is excellent. More than 90% of the patients with de Quervain thyroiditis recover completely, with or without treatment.
 
Case References
  1. Zacharia TT, Perumpallichira JJ, Sindhwani V, Chavhan G. Gray-scale and color Doppler sonographic findings in a case of subacute granulomatous thyroiditis mimicking thyroid carcinoma. J Clin Ultrasound 2002;30:442-444
  2. Langer JE, Khan A, Nisenbaum HL, Baloch ZW, Horii SC, Coleman BG, et al. Sonographic appearance of focal thyroiditis. AJR Am J Roentgenol 2001; 176:751-754
  3. Sun Young Park, et alt: Ultrasonographic Characteristics of Subacute Granulomatous Thyroiditis. Korean J Radiol 2006;7:229-234

General information sources:
http://en.wikipedia.org/wiki/De_Quervain's_thyroiditis
http://emedicine.medscape.com/article/117446-overview
 
Technical Details Case provided courtesy of Dr. Danilo Sirigu, founder of the ecomovies web site.  To view a wide range of high quality ultrasound video cases please visit Ecomovies at http://www.ecomovies.it/index.asp