Endocrine: subacute granulomatous thyroiditis: practice question

A Pathology 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.

Try it

Pathology · Endocrine: subacute granulomatous thyroiditis

Sample item

A 38-year-old woman has a painful tender thyroid with fever two weeks after a viral illness. ESR is high, T4 is raised, TSH is suppressed and radioiodine uptake is very low. Biopsy shows granulomatous inflammation with multinucleate giant cells. Which clinical course is expected?

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

The answer and the reasoning

A. Transient thyrotoxicosis, then a hypothyroid phase, then recovery in most patients

In subacute (de Quervain) thyroiditis, follicle destruction releases preformed hormone, causing thyrotoxicosis with suppressed TSH and a low radioiodine uptake because the damaged follicles do not take up iodine. After depletion of stores a transient hypothyroid phase follows, and most patients recover. Treatment is anti-inflammatory with beta-blockers for symptoms.

Option by option

  • A. Transient thyrotoxicosis, then a hypothyroid phase, then recovery in most patients (correct)

    Correct. Thyrotoxicosis with low uptake is followed by hypothyroidism and recovery.

  • B. Permanent hypothyroidism from anti-TPO mediated lymphocytic destruction

    Hashimoto thyroiditis causes painless goitre with lymphoid follicles and Hurthle cells.

  • C. Persistent hyperthyroidism from TSH receptor antibodies requiring thyroidectomy

    Graves disease causes persistent hyperthyroidism with high iodine uptake and no tenderness.

  • D. Hyperthyroidism from an autonomous nodule with high iodine uptake

    An autonomous nodule has high or focal uptake and is painless.

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 Pathology questions

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is A, Transient thyrotoxicosis, then a hypothyroid phase, then recovery in most patients. In subacute (de Quervain) thyroiditis, follicle destruction releases preformed hormone, causing thyrotoxicosis with suppressed TSH and a low radioiodine uptake because the damaged follicles do not take up iodine.

Why is "Permanent hypothyroidism from anti-TPO mediated lymphocytic destructi…" not the answer?

Hashimoto thyroiditis causes painless goitre with lymphoid follicles and Hurthle cells.

Why is "Persistent hyperthyroidism from TSH receptor antibodies requiring thy…" not the answer?

Graves disease causes persistent hyperthyroidism with high iodine uptake and no tenderness.

Why is "Hyperthyroidism from an autonomous nodule with high iodine uptake" not the answer?

An autonomous nodule has high or focal uptake and is painless.

What concept does this question test?

It tests Endocrine: subacute granulomatous thyroiditis in Pathology. After depletion of stores a transient hypothyroid phase follows, and most patients recover. Treatment is anti-inflammatory with beta-blockers for symptoms.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Endocrine: subacute granulomatous thyroiditis?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology 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.