Subacute (de Quervain's) thyroiditis. (Pathology Clinic).Subacute (de Quervain's) thyroiditis Thyroiditis Definition Thyroiditis is inflammation of the thyroid gland, a butterfly-shaped organ next to the windpipe. Description The thyroid is the largest gland in the neck. is a seasonal disorder that generally affects middle-aged women. It is characterized by neck pain and generalized malaise, fatigue, fever, and chills following an upper respiratory infection, usually of viral etiology. Thyroid gland palpation palpation /pal·pa·tion/ (pal-pa´shun) the act of feeling with the hand; the application of the fingers with light pressure to the surface of the body for the purpose of determining the condition of the parts beneath in physical diagnosis. elicits exquisite tenderness of the firm gland, which can be involved either focally or diffusely. The stage of the disease determines whether there is hyper- or hypothyroidism. Fine-needle aspiration specimens contain acute inflammatory cells in a background of mixed inflammatory cells and multinucleated multinucleated characterized by having more than one nucleus per cell. multinucleated giant cell see giant cell. giant cells with degenerated thyroid follicular epithelial cells. The thyroid gland displays ill-defined nodules made up of fibrous tissue, damaged thyroid follicular epithelial cells (eosinophilic eosinophilic /eo·sin·o·phil·ic/ (-fil´ik) 1. readily stainable with eosin. 2. pertaining to eosinophils. 3. pertaining to or characterized by eosinophilia. cytoplasm with round, hyperchromatic nuclei), and extravasation extravasation /ex·trav·a·sa·tion/ (ek-strav?ah-za´shun) 1. a discharge or escape, as of blood, from a vessel into the tissues; blood or other substance so discharged. 2. the process of being extravasated. of colloid (figure 1). The inflammatory process has a distinctly granulomatous pattern, characterized by the presence of foreign-body-type giant cells (multiple irregularly shaped nuclei in abundant cytoplasm) (figure 2, A), chronic inflammatory cells (mature lymphocytes and plasma cells), and microabscess formation (figure 2, B); the latter is made up of acute inflammatory cells (neutrophils with three or four lobes to the nuclei surrounded by granularcytoplasm). As the disease progresses, a variable degree of fibrosis and regeneration of the follicular epithelium becomes evident. The histologic differential diagnosis includes palpation thyroiditis (histiocytes, lymphocytes, and no neutrophils), lymphocytic thyroiditis (oxyphilic [Hurthle, oncocytic] follicular epithelial cell metaplasia with mature lymphocytes and plasma cells arranged around germinal centers), and Riedel's thyroiditis (vasculitis and fibrosis). Corticosteroid therapy usually results in symptom resolution in 4 to 6 weeks. Salicylates Salicylates A group of drugs that includes aspirin and related compounds. Salicylates are used to relieve pain, reduce inflammation, and lower fever. and other nonsteroidal anti-inflammatory medications have also been effective. Surgery is generally not indicated. Suggested reading Kitchener MI, Chapman IM. Subacute thyroiditis: A review of 105 cases. Clin Nucl Med 1989;14:439-42. Singer PA. Thyroiditis. Acute, subacute, and chronic. Med Clin North Am 1991;75:61-77. From the Department of Endocrine and Otorhinolaryngic Head and Neck Pathology, Armed Forces Institute of Pathology Armed Forces Institute of Pathology A section of the US military which provides consultations, reference atlases and educational programs for pathologists , Washington, D.C. |
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