Korean J Radiol.  2006 Dec;7(4):229-234. 10.3348/kjr.2006.7.4.229.

Ultrasonographic Characteristics of Subacute Granulomatous Thyroiditis

• Park SY
• Kim EK
• Kim MJ
• Kim BM
• Oh KK
• Hong SW
• Park CS

• KMID: 1092545
• DOI: http://doi.org/10.3348/kjr.2006.7.4.229

Abstract

OBJECTIVE
We wanted to describe the characteristic ultrasonography (US) features and clinical findings for making the diagnosis of subacute granulomatous thyroiditis. MATERIALS AND METHODS: A total of 31 lesions from 27 patients were confirmed as subacute granulomatous thyroiditis by US-guided fine needle aspiration biopsy. We analyzed the ultrasonographic findings such as the lesion's size, margin and shape, the discrepancy between length and breadth and the vascularity. The clinical findings such as acute neck pain or fever were reviewed. The follow-up clinical and ultrasonographic data were reviewed for 15 patients. RESULTS: The thyroid gland was found to be enlarged in five patients, it was normal size in 20 patients and it was smaller in two patients. All the lesions had focally ill-defined hypoechogenicity. Hypervascularity was not noted in any of the lesions. Painful neck swelling was present in 18 patients. An accompanying fever was documented in nine of the 18 patients. Twelve patients showed disappearance (n = 3) or a decreased size (n = 9) of their lesions on follow-up US. CONCLUSION: The presence of ill-defined hypoechoic thyroid lesions without a discrete round or oval shape is characteristic for subacute granulomatous thyroiditis, and particularly when this is associated with painful neck swelling and/or fever.

Keyword

Thyroid; Ultrasound (US); Thyroiditis

MeSH Terms

Ultrasonography, Interventional
Thyroiditis, Subacute/pathology/*ultrasonography
Middle Aged
Male
Humans
Granuloma/pathology/*ultrasonography
Female
Biopsy, Fine-Needle
Aged
Adult

Figure

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  Fig. 1 A 62-year-old woman with diffuse neck swelling and malaise. The laboratory tests suggested normal thyroid function. The transverse right (A) and left (B), and longitudinal right (C) and left (D) thyroid sonograms show ill-defined hypoechoic lesions involving nearly the entire area of both thyroid glands. Both thyroids are diffusely enlarged, but no cervical lymphadenopathy was detected. Subacute granulomatous thyroiditis was confirmed by fine needle aspiration biopsy. The patient's condition improved dramatically following steroid treatment.

• 

  Fig. 2 A 45-year-old woman with severe neck pain and low-grade fever. The transverse (A) and longitudinal (B) sonograms of the right thyroid reveal an ill-defined elongated hypoechoic lesion, which is a typical finding of subacute thyroiditis. Color Doppler ultrasonography (C) shows no vascular flow in the hypoechoic lesion. Cytology suggests subacute granulomatous thyroiditis (D). On the day after steroid therapy, the patient felt free of neck pain. On sonogram after two months (E, F), the size of the hypoechoic area was markedly decreased.

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  Fig. 3 A 50-year-old woman with neck swelling. Transverse (A) and longitudinal (B) sonograms of the left thyroid show an ill-defined, markedly hypoechoic lesion mimicking a malignant nodule. Subacute granulomatous thyroiditis was confirmed by performing fine needle aspiration biopsy. On the follow-up longitudinal sonogram after one month of medication (C), the lesion is not clearly visualized.

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