View source for WBR0069

 {{WBRQuestion
|QuestionAuthor=Mahmoud Sakr, M.D.
|ExamType=USMLE Step 2 CK
|MainCategory=Internal medicine
|SubCategory=Endocrine, Endocrine
|MainCategory=Internal medicine
|SubCategory=Endocrine, Endocrine
|MainCategory=Internal medicine
|SubCategory=Endocrine, Endocrine
|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Endocrine, Endocrine
|MainCategory=Internal medicine
|SubCategory=Endocrine, Endocrine
|MainCategory=Internal medicine
|SubCategory=Endocrine, Endocrine
|MainCategory=Internal medicine
|SubCategory=Endocrine, Endocrine
|MainCategory=Internal medicine
|MainCategory=Internal medicine
|SubCategory=Endocrine, Endocrine
|Prompt=33 y/o African American woman presents with malaise, constipation and intolerance to cold weather. Physical examination reveals an enlarged thyroid gland that’s soft, diffuse, nodular and mobile. Her TSH is elevated and her T3 and T4 are decreased. Anti thyroglobulin antibodies are positive. The patient was referred to an endocrinologist for a fine needle aspiration. Which of the following cells will be predominant on her biopsy results?
|Explanation=The correct answer is B. 
This patient has Hashimoto’s thyroiditis. Hashimoto's thyroiditis (chronic autoimmune thyroiditis) is the most common cause of hypothyroidism in iodine-sufficient areas of the world. It is characterized clinically by gradual thyroid failure, goiter formation, or both, due to autoimmune-mediated destruction of the thyroid gland involving apoptosis of thyroid epithelial cells.  Nearly all patients have high serum concentrations of antibodies against one or more thyroid antigens, diffuse lymphocytic infiltration of the thyroid, which includes predominantly thyroid-specific B and T cells, and follicular destruction.
|AnswerA=Multinucleate giant cells
|AnswerAExp=Incorrect! This would be related to de Quervain's thyroiditis or giant cell thyroiditis.
|AnswerB=Lymphocytes
|AnswerBExp=Correct! The characteristic histopathological abnormalities in Hashimoto's are profuse lymphocytic infiltration, lymphoid germinal centers, and destruction of thyroid follicles.
|AnswerC=Neutrophils
|AnswerCExp=Incorrect! Neutrophils are Found in subacute granulomatous thyroiditis, not Hashimoto's.
|AnswerD=Parafollicular C cells
|AnswerDExp=Incorrect! This would be correct if the suspected diagnosis is medullary thyroid cancer.
|AnswerE=Eosinophils
|AnswerEExp=Incorrect! There has been reports that eosinophils can be detected on tissue biopsies of Hashimoto's. However, this is still under investigation. The predominant cells are always lymphocytes in hashimoto's.
|RightAnswer=B
|Approved=Yes
}}