Case #3:  Case contributed by Maj. Rohit Tewari, MD(Path); Ambala. India.

A thirty year old lady presented with a swelling in the front of the neck associated with pain and fever for the past two weeks. She gave history of an upper respiratory infection 3 weeks prior to the development of these symptoms. On examination, she had a diffuse swelling in the front of the neck which was moving with deglutition. Tenderness was present. A nodule was also palpable on the right side (Fig. 1). Her hemoglobin was 11.5 gm/dl, TLC 9900/cmm and ESR was 32 mm fall at the end of one hour (Wintrobe).

Her Thyroid function tests revealed T3 - 2.91 ng/ml (0.8-2.0 ng/ml), T4 - 22.65 mgm/dl (4.5-12.0 mgm/dl) and TSH - 0.01 µIU/ml (0.3-5.0 µIU/ml).

USS of the thyroid showed thyromegaly with coarse echotexture and a  2.0 x 1.7 cm nodule on the right side.

She was referred for FNAC.


Fig.1:  Clinical photograph - Diffuse tender thyroid swelling with a nodule 2 x 1.7 cm in the right lobe.

Fig. 2:  Good cellularity, dirty background (Leishman, x100).

Fig.3:  A mixed infiltrate of lymphocytes, histiocytes, epithelioid cells and large number of multinucleate giant cells was seen in addition to the degenerated follicular epithelium (Leishman, x 200).


Fig.4:  Multinucleated giant cell with numerous nuclei at higher magnification (Leishman, x 400).

Fig. 5:  Coarse blue ‘paravacuolar’ granules were seen in the cytoplasm of the epithelial cells (Leishman, x 200).

Fig.6:  Abundant colloid was seen (Leishman, x 400).