All Sample Questions

Hashimoto's Thyroiditis 2

Question

Vignette: A 55-year-old woman presents to her primary care physician with complaints of severe fatigue and a 10-pound weight loss over the past 6 months. She also reports feeling cold all the time and has noticed changes in her voice. Physical examination reveals a large, non-tender mass in the anterior neck. Laboratory findings indicate hypothyroidism. A biopsy of the thyroid gland is performed, which reveals abundant lymphocytic infiltration with formation of germinal centers. The surrounding thyroid follicles are atrophic. Which of the following is the most likely diagnosis?

Choices

A. Graves' disease

B. Hashimoto's thyroiditis

C. Multinodular goiter

D. Papillary thyroid carcinoma

E. Subacute thyroiditis

Answer

B. Hashimoto's thyroiditis

Explanation

The clinical picture is suggestive of hypothyroidism, indicated by fatigue, weight gain, cold intolerance, and changes in voice. The presence of a goiter along with lymphocytic infiltration with germinal centers on biopsy is characteristic of Hashimoto's thyroiditis, an autoimmune disorder that is the most common cause of hypothyroidism in areas of the world where iodine levels are sufficient. It is caused by autoantibodies against thyroid peroxidase and thyroglobulin, leading to lymphocytic infiltration of the thyroid and gradual destruction of the gland. The disease is more common in women and often presents in middle age.