WBR0672
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| Author | [[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Serge Korjian)]] |
|---|---|
| Exam Type | USMLE Step 1 |
| Main Category | Pathology |
| Sub Category | Endocrine |
| Prompt | A 42-year-old Korean woman, with no significant past medical history, presents to the physician's office with complaints of excessive fatigue and weight gain. Upon further questioning, the patient reports she has recent developed constipation, hair loss, and somnolence. Physical examination is remarkable for a palpable thyroid mass. Following appropriate work-up, the patient is found to have elevated TSH, low FT4, and elevated levels of anti-thyroid peroxidase antibodies (anti-TPO). Which of the following conditions is known to be associated with the patient's disease? |
| Answer A | Non-Hodgkin's lymphoma |
| Answer A Explanation | Non-Hodgkin's lymphoma (NHL) is associated with Hashimoto's thyroiditis. |
| Answer B | Hodgkin's lymphoma |
| Answer B Explanation | Hodgkin's lymphoma is not associated with Hashimoto's thyroiditis. |
| Answer C | Acute myelogenous leukemia |
| Answer C Explanation | Acute myelogenous leukemia (AML) is not associated with Hashimoto's thyroiditis. |
| Answer D | Chronic myelogenous leukemia |
| Answer D Explanation | Chronic myelogenous leukemia (CML) is not associated with Hashimoto's thyroiditis. |
| Answer E | Chronic lymphocytic leukemia |
| Answer E Explanation | Chronic lymphocytic leukemia (CLL) is not associated with Hashimoto's thyroiditis. |
| Right Answer | A |
| Explanation | The patient is presenting with symptoms and signs consistent with Hashimoto's thyroiditis. She reports excessive fatigue, sleepiness, weight gain, cold intolerance, hair loss, and constipation - all of which are symptoms of hypothyroidism. Furthermore, physical examination confirms a thyroid pathology; and work-up makes the diagnosis of Hashimoto's thyroiditis most likely due to the presence of anti-TPO (positive in 90% of Hashimoto's thyroiditis cases). Hashimoto's thyroiditis is known to be associated with Non-Hodgkin's lymphoma (NHL). The most common form of thyroid NHL in patients with Hashimoto's thyroiditis is a low grade B-cell lymphoma of MALT type. Thyroid NHL is 4 times more common in women than in men, and up to 50% of the these patients have a history of Hashimoto's thyroiditis. The most common clinical manifestations are related to a rapidly the rapidly enlarging mass and include progressive goiter and compression symptoms. Educational Objective: Hashimoto's thyroiditis is associated with Non-Hodgkin's lymphoma. |
| Approved | Yes |
| Keyword | Hashimoto's thyroiditis, Hypothyroidism, Autoimmune diseases, Non-Hodgkin's lymphoma, Thyroid nodule |
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