Thyroid diseases impact millions of individuals worldwide, spanning diverse age groups and demographics, making it one of the most prevalent endocrine illnesses globally. Thyroiditis is one of these ailments which manifests itself in several ways, each with unique clinical characteristics and etiologies.
Subacute granulomatous thyroiditis, another name for De Quervain's thyroiditis, is a very uncommon kind of thyroiditis with an incidence of 12.1 cases per 100,000 people per year.1, 2 Even though Mygind originally characterized SAT in 1895, the precise etiology and factors influencing its clinical trajectory are still unknown. [3,4]

It is associated with a viral upper respiratory tract infection and is characterized by inflammatory response, a painfully enlarged thyroid gland, and temporary hyperthyroidism. Although the precise prevalence of De Quervain's thyroiditis is unknown, it is thought to be a rare illness that is frequently misdiagnosed because of its vague symptoms.  This case series is a comparison of clinical, sonological, biochemical and cytological parameters observed in this disease at a private diagnostic centre.

This is a retrospective case-based analysis of patients who were diagnosed to have Dequervain’s thyroiditis at a private diagnostic centre between 2021 and 2023

A total of 656 cases of thyroid lesions underwent FNAC during the study period with the following diagnoses: (Table 1)

The present study on DT had 11 females and 3 males, all aged between 32 yrs to 51 yrs. The presenting complaint among all patients was a painful swelling in the anterior aspect of the neck. Most patients complained about unilateral pain on the involved side with occasional occurrence of bilateral pain. Six patients complained of radiation of pain towards the ipsilateral ear and 3 patients had vague dysphagia and/or odynophagia. The duration of symptoms ranged from a month to 6 months. Five patients mentioned history of fever within 1 year of development of symptoms. Cervical lymphadenopathy was absent in all cases. In all patients, the swelling in the neck moved up and down with deglutition, and thus, was considered as thyroid swelling. Two patients gave a positive history of palpitations and increased sweating.

During clinical examination, all showed tenderness on palpation. Nodularity in the thyroid was noted in 5 patients (35.7%) during palpation whereas rest of them had diffuse swelling of the thyroid.

NEW: Three of these five patients also had Thyroid Follicular Nodular Disease (TFND; or Nodular Goitre) and had elevated T3/T4 levels. On USG, they showed solid wider than taller nodules

Thyroid nodules are common, seen in about 8.5% of the population.[5,6] They are more common among women. In India the prevalence of a palpable thyroid nodule in the community is about 12.2%, according to a study.[7]

In the present study, we observed a total of 656 cases of lesions of thyroid during a period of 24 months. Majority of cases were diagnosed as Nodular Goitre (21.3%) followed by Follicular neoplasm (21.1%) and Hashimoto’s thyroiditis (19.9%).

We found Dequervain’s thyroiditis in 14 patients 11 of whom were females. The median age was 40.5 +_ 6.03 years. The presenting complaint in all patients was painful swelling in the anterior aspect of the neck which moves up and down with deglutition. The primary clinical diagnosis is often nodular goitre or malignancy. In such cases, after clinical examination, the primary modalities of investigations are radiology and cytology. [8]
On USG, if nodules are observed, physicians incline towards malignancy. We found that 71.4% patients showed presence of hypoechoic nodules on USG, similar to Li et al [8] and Yoo Jin Lee et al [9]. The hypoechoic lesions are solid in nature and thus may be confused for malignancy. Increased blood flow in the periphery of the lesion was seen in 4/14 cases (42.8%), whereas than Yoo Jin Lee et al [9] found in 5% of cases. Although higher vascularity is usually noticed in primary hyperplasia of thyroid, in the present study, it may be due to the presence of surrounding inflammation.

Eleven patients were hyperthyroid, including subclinically, with 7 cases with nodule(s) on USG. In such cases, FNAC is required to rule out toxic goitre. The accumulation of colloid and rupture of the nodule may cause acute bouts of pain. One patient even mentioned their attempts to compress the swelling with pressure which caused mild increase in pain.

On FNAC, all cases showed chronic lymphoplasmacytic inflammation and granulomas with 6 cases showing multinucleated osteoclast like giant cells engulfing colloid. The thyroid follicular cells showed paranuclear vacuolations, which is a feature of DT. Occasional scattered Hurthle cells were seen but were considered to be a degenerative change rather than an indicator of Hashimoto’s thyroiditis. Scant colloid was seen in all cases in the background. Thus, Grave’s disease and toxic goitre were ruled out and a diagnosis of DT was made in these cases.  The treatment for Grave’s disease is radioactive iodine therapy and/or ablation of thyroid tissue in extreme cases whereas for toxic nodular goitre, the treatment is often than not surgical. Similar observations were made by Tabossom et al [10] and Warpe et al [11].

Five patients also gave history of fever preceding the swelling which could point towards acute suppurative thyroiditis as well. Few studies have also suggested that SARS-CoV-2, mumps, measles, coxsackie, and adenovirus may lead to development of DT. [9,12] Six cases also showed elevation of inflammatory serum markers like ESR or CRP, which highlights the inflammatory nature of the process.

All these patients were treated with anti-inflammatory medication following which their symptoms subsided. Ten patients were followed up for a period of six months following which 8 patients had disappearance of pain and nodules whereas 2 patients were remained hypothyroid. These patients had elevated TSH during presentation.

As thyroid lesions are being diagnosed increasingly, it is important to remember that certain lesions present dangerously but may be completely indolent in behaviour and must not be over treated.

DT may appear dangerously neoplastic at presentation but resolves spontaneously or with anti-inflammatory medication. FNAC is a vital tool for differentiating between malignancies and other significant thyroid diseases, as well as subacute thyroiditis and in preventing needless surgical operations and guaranteeing suitable and conservative treatment. FNAC provides early and precise diagnosis and alleviates anxiety among patients

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