WBR0518

Author	[[PageAuthor::Gonzalo A. Romero, M.D. [1]]]
Exam Type	ExamType::USMLE Step 2 CK
Main Category
Sub Category	SubCategory::Endocrine
Prompt	[[Prompt::A 45-year-old female comes to the physician due to a 6-month history of difficulty swallowing. She is very worried because her condition is getting worse. At first, she thought it was a cold. Review of systems is significant for dyspnea and stridor. Upon examination her vitals are within normal limits, her neck is supple without JVD and her thyroid has a hard consistency and non-mobile. Her TSH and free T3 and T4 are within normal limits. A fine needle aspiration is performed on it shows dense collagenous replacement of the thyroid gland with chronic inflammation. Which of the following complications is this patient most likely to develop?]]
Answer A	AnswerA::Papillary carcinoma of the thyroid
Answer A Explanation	[[AnswerAExp::Papillary carcinoma of the thyroid is the most common type of thyroid cancer 75 to 85% of cases of all thyroid cancers. Microscopically is seen as with the characteristic Orphan Anney eye nuclear inclusions (nuclei with uniform staining) and psammoma body (laminated concentric calcifications).]]
Answer B	AnswerB::Retroperitoneal fibrosis
Answer B Explanation	[[AnswerBExp::Riedel's thyroiditis can involve mediastinal and retroperitoneal fibrosis.]]
Answer C	AnswerC::Thyroid storm
Answer C Explanation	[[AnswerCExp::Thyroid storm is defined as a sudden elevation of the thyroid hormones. Riedel thyroiditis is not associated with thyroid storm. Contrary, it is associated with hypothyroidism.]]
Answer D	AnswerD::Pneumonia
Answer D Explanation	[[AnswerDExp::Although mediastinal fibrosis could potentially lead to peribronchial fibrosis, riedel thyroiditis is not commonly associated with pneumonia.]]
Answer E	AnswerE::Thyroid lymphoma
Answer E Explanation	[[AnswerEExp::Thyroid lymphoma is a rare complication of Hashimoto thyroiditis.]]
Right Answer	RightAnswer::B
Explanation	[[Explanation::This patient is presenting with symptoms and signs of Riedel's thyroiditis, a chronic inflammatory disease of the thyroid, which causes fibrosis. The fibrosis can extend to adjacent structures causing dysphagia, dyspnea, dysphonia and hoarseness (due to the laryngeal nerve involvement), hypoparathyroidism. 30% of patients present with hypothyroidism, but most patients are euthyroid. Educational Objective: Riedel thyroiditis can cause mediastinal and retroperitoneal fibrosis References: First Aid 2014 page 321]]
Approved	Approved::Yes
Keyword	WBRKeyword::Riedel thyroiditis, WBRKeyword::Thyroiditis
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::