Sandbox:DDx HEENT: Difference between revisions

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* 15-30 yo women  
* 45-50 yo women  
* Fatigue, weight gain, cold intolerance, constipation, myopathy, depression, menorrhagia, and infertility
* Neck tightness
* Dyspnea, dysphagia, and hoarseness


* Nontender mild neck swelling
* Gradual onset of wood-hard, painless, fixed goiter
* Puffy face, bradycardia, and dry skin
* Lymphadenopathy is absent


* Decreased T3/T4 and increased TSH
* Elevated ESR
* Anti-thyroid peroxidase antibodies
* Elevated IgG4
* Elevated cholesterol levels
* Normal T3, T4, and TSH


* Hypoechoic thyroid gland with coarse or "micronodular" echotexture on U/S
* Homogeneously hypochoic
* Increased vascularity of the gland
* Diffuse borders of the gland  
* Decreased iodine uptake on thyroid scan


* Extensive T cell lymphocytic infiltrate
* Broad bands of fibrosis
* Nuclear clearing
* Lymphohistiocytic infiltrate 
* Germinal center formation
* Hürthle cells and giant cells
* Fibrosis


 
* Not applicable
* HLA-DR5
* CTLA4

Revision as of 22:00, 1 November 2015

  • 45-50 yo women
  • Neck tightness
  • Dyspnea, dysphagia, and hoarseness
  • Gradual onset of wood-hard, painless, fixed goiter
  • Lymphadenopathy is absent
  • Elevated ESR
  • Elevated IgG4
  • Normal T3, T4, and TSH
  • Homogeneously hypochoic
  • Diffuse borders of the gland
  • Decreased iodine uptake on thyroid scan
  • Broad bands of fibrosis
  • Lymphohistiocytic infiltrate
  • Not applicable
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