Int J Thyroidol.  2021 Nov;14(2):180-185. 10.11106/ijt.2021.14.2.180.

Subacute Thyroiditis Developed While Waiting for Papillary Thyroid Cancer Surgery: Pathologically Proven Two Cases

• Kim DH
• Hong CM
• Han MH
• Lee J

• KMID: 2522925
• DOI: http://doi.org/10.11106/ijt.2021.14.2.180

Abstract

Co-existence of subacute thyroiditis and papillary thyroid cancer (PTC) is rarely reported. We have recently experienced interesting cases of subacute thyroiditis, which developed while waiting for elective surgery of thyroid cancer in two patients. Two women, aged 52 and 55 years, suspected or diagnosed as PTC complained of anterior neck pain and febrile sensation several weeks before the scheduled surgery. Both cases showed elevated serum thyroid hormones and erythrocyte sedimentation rate, and decreased thyroid-stimulating hormone. Ill-defined hypoechoic lesions on ultrasonography and decreased uptake on Tc-99m pertechnetate scan were noted in both lobes. Total thyroidectomy for PTC was performed after relief of symptoms either by steroid or non-steroid anti-inflammatory drug treatment. Pathologic evaluation of surgical specimen revealed multinucleated giant cells and mononuclear cell infiltration. Pathognomic findings of subacute thyroiditis in addition to PTC were observed in both cases.

Keyword

Subacute thyroiditis; Papillary thyroid cancer; Thyroid nodule; Hypoechoic area

Figure

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  Fig. 1 Image and histopathological findings of patient 1. Longitudinal (A) and transverse (B, C) thyroid ultrasonographic images. Longitudinal image (A) shows a well-defined, 1.0 × 1.2 cm sized hypoechoic, microcalcified nodule in the right lobe and strap muscle invasion of the nodule is suspected. In addition, diffuse hypoechogenicity was noted adjacent to the thyroid nodule. Transverse image (B) reveals an ill-defined hypoechoic area in the subcapsular area of the left lobe, findings compatible with thyroiditis. Follow-up transverse image (C) shows recovery from thyroiditis. Tc-99m pertechnetate thyroid scan (D) shows marked decreased tracer uptake in both lobes of the thyroid. (E) (H&E stain, ×40) and (F) (H&E stain, ×200) show papillary carcinoma. Papillary carcinoma is associated with interstitial fibrosis that results from desmoplastic changes due to carcinoma. (G) (H&E stain, ×100) and (H) (H&E stain, ×200) show granulomatous inflammation and interstitial fibrosis with multinucleated giant cells, which suggest subacute thyroiditis.

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  Fig. 2 Image and histopathological findings of patient 2. Neck CT (A) show a large well-demarcated low-dense nodule in the left lobe. In addition, the transverse image of neck ultrasonography (B) shows a large heterogeneous hypoechoic nodule in the left lobe, which was confirmed as a follicular variant of papillary carcinoma after surgery. Transverse image (C) shows diffuse ill-defined hypoechogenicity in the subcapsular area; it looks taller than wide and has a speculated margin. FNAC was performed at the hypoechoic nodule, and the result showed AUS. In the follow-up ultrasonographic image (D), the hypoechoic nodule has significantly and the subcapsular diffuse hypoechogenicity has improved. (E) (H&E stain, ×40) and (F) (H&E stain, ×400) show papillary carcinoma with encapsulated follicular variant. (G) (H&E stain, ×100) and (H) (H&E stain, ×100) show granulomatous inflammation and interstitial fibrosis with multinucleated giant cells, which suggest subacute thyroiditis.

Reference

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