Endocrinology: subacute thyroiditis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Endocrinology: subacute thyroiditis

Sample item

Two weeks after an upper respiratory tract infection, a 38-year-old woman has fever, a painful tender thyroid and palpitations. Free T4 is raised, TSH is suppressed and ESR is 80 mm/h. Which investigation best distinguishes this from Graves disease?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Radioactive iodine uptake showing low uptake

Subacute (de Quervain) thyroiditis is a viral-associated inflammation in which stored hormone leaks out of damaged follicles, causing a self-limited thyrotoxic phase. The gland is not synthesising hormone and TSH is suppressed, so radioiodine uptake is low. In Graves disease, uptake is high and diffuse. Treatment is NSAIDs and a beta-blocker, with steroids in severe pain.

Option by option

  • A. A high titre of anti-TPO antibody

    Anti-TPO is present in autoimmune thyroid disease and does not separate these entities.

  • B. Positive TSH receptor antibody

    TSH receptor antibodies are characteristic of Graves disease.

  • C. Radioactive iodine uptake showing low uptake (correct)

    Destructive thyrotoxicosis gives a low radioiodine uptake, unlike hyperfunction.

  • D. Radioactive iodine uptake showing diffusely high uptake

    Diffusely high uptake is the pattern of Graves disease.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Radioactive iodine uptake showing low uptake. Subacute (de Quervain) thyroiditis is a viral-associated inflammation in which stored hormone leaks out of damaged follicles, causing a self-limited thyrotoxic phase.

Why is "A high titre of anti-TPO antibody" not the answer?

Anti-TPO is present in autoimmune thyroid disease and does not separate these entities.

Why is "Positive TSH receptor antibody" not the answer?

TSH receptor antibodies are characteristic of Graves disease.

Why is "Radioactive iodine uptake showing diffusely high uptake" not the answer?

Diffusely high uptake is the pattern of Graves disease.

What concept does this question test?

It tests Endocrinology: subacute thyroiditis in General Medicine. The gland is not synthesising hormone and TSH is suppressed, so radioiodine uptake is low. In Graves disease, uptake is high and diffuse. Treatment is NSAIDs and a beta-blocker, with steroids in severe pain.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrinology: subacute thyroiditis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.