A 28-year-old patient presented with painless thyroid swelling that showed features of a hydatid cyst on resection. The preoperative cytology had been reported as unsatisfactory. A review of the smears revealed the presence of acellular laminated membranes overlooked initially. Infection as a cause of thyroiditis is rare and can be bacterial, fungal, and less commonly parasitic or viral. Most patients have a predisposing factor like a congenital surgical anomaly or an immunocompromised status. Infection may also be iatrogenic; post-fine needle cytology being an important cause. Subacute thyroiditis having an overlapping clinical presentation is an important differential diagnosis. The cytological examination provides an integral modality for diagnosis, allowing microscopic evaluation and procurement of material for culture and sensitivity studies. However, a high index of suspicion is essential to avoid missed or misdiagnosis. Here, we review the various causative agents of infectious thyroiditis, discussing the cytological features and differential diagnosis.
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