WBR0142: Difference between revisions
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|SubCategory=Endocrine | |SubCategory=Endocrine | ||
|Prompt=A previously healthy 27-year-old female patient presents to her primary care physician for generalized fatigue and difficulty concentrating for the past three months. She reports hair loss, dry skin, constipation and cold intolerance. Serology for antithyroid peroxidase antibodies is positive. This patient’s condition increases her risk of developing which of the following malignancies? | |Prompt=A previously healthy 27-year-old female patient presents to her primary care physician for generalized fatigue and difficulty concentrating for the past three months. She reports hair loss, dry skin, constipation and cold intolerance. Serology for antithyroid peroxidase antibodies is positive. This patient’s condition increases her risk of developing which of the following malignancies? | ||
|Explanation=This patient is suffering from fatigue, constipation, cold intolerance and decreased concentration which are all suggestive of hypothyroidism. | |Explanation=This patient is suffering from fatigue, constipation, cold intolerance and decreased concentration which are all suggestive of hypothyroidism. A positive test for [[antimicrosomal antibody|antithyroid peroxidase antibodies]] is highly specific for [[Hashimoto's thyroiditis]], an autoimmune disease in which these antibodies destroy the follicles of the thyroid. It is the most common cause of hypothyroidism and is associated with the HLA-DR5 serotype. Affected patients may show signs of hyperthyroidism early in the disease course, as thyroid hormone is released from disrupted follicles. However, patients eventually proceed to a hypothyroid state. On physical examination, patients often have a moderately enlarged, nontender thyroid. Laboratory finding in all hypothyroid patients include elevated TSH with decreased concentrations of free T3 and T4. | ||
[[Hashimoto's thyroiditis]] is associated with increased risk of thyroid [[lymphoma]]. | |||
|AnswerA=Papillary carcinoma of the thyroid | |AnswerA=Papillary carcinoma of the thyroid | ||
|AnswerAExp=This patient has Hashimoto’s disease. It does not increase the risk of developing papillary carcinoma of the thyroid. | |AnswerAExp=This patient has Hashimoto’s disease. It does not increase the risk of developing papillary carcinoma of the thyroid. | ||
Revision as of 16:15, 12 July 2014
| Author | [[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by William J Gibson)]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Pathology |
| Sub Category | SubCategory::Endocrine |
| Prompt | [[Prompt::A previously healthy 27-year-old female patient presents to her primary care physician for generalized fatigue and difficulty concentrating for the past three months. She reports hair loss, dry skin, constipation and cold intolerance. Serology for antithyroid peroxidase antibodies is positive. This patient’s condition increases her risk of developing which of the following malignancies?]] |
| Answer A | AnswerA::Papillary carcinoma of the thyroid |
| Answer A Explanation | AnswerAExp::This patient has Hashimoto’s disease. It does not increase the risk of developing papillary carcinoma of the thyroid. |
| Answer B | AnswerB::Follicular carcinoma of the thyroid |
| Answer B Explanation | AnswerBExp::This patient has Hashimoto’s disease. It does not increase the risk of developing follicular carcinoma of the thyroid. |
| Answer C | AnswerC::Medullary carcinoma of the thyroid |
| Answer C Explanation | [[AnswerCExp::Medullary carcinoma of the thyroid is associated with Multiple Endocrine Neoplasia type IIB (MEN2B), but not with Hashimoto's thyroiditis.]] |
| Answer D | AnswerD::Lymphoma of the thyroid |
| Answer D Explanation | [[AnswerDExp::Thyroid lymphoma affects predominantly females over 70 years of age with a history of Hashimoto's thyroiditis. Thus, Hashimoto's thyroiditis is considered as risk factor for the development of thyroid lymphoma. The thyroid lymphoma manifests as rapidly enlarging neck mass causing respiratory difficulty. On physical examination, patients usually exhibit a firm thyroid and lymphadenopathy.]] |
| Answer E | AnswerE::Anaplastic carcinoma of the thyroid |
| Answer E Explanation | AnswerEExp::This patient has Hashimoto’s disease. It does not increase the risk of developing anaplastic carcinoma of the thyroid. |
| Right Answer | RightAnswer::D |
| Explanation | [[Explanation::This patient is suffering from fatigue, constipation, cold intolerance and decreased concentration which are all suggestive of hypothyroidism. A positive test for antithyroid peroxidase antibodies is highly specific for Hashimoto's thyroiditis, an autoimmune disease in which these antibodies destroy the follicles of the thyroid. It is the most common cause of hypothyroidism and is associated with the HLA-DR5 serotype. Affected patients may show signs of hyperthyroidism early in the disease course, as thyroid hormone is released from disrupted follicles. However, patients eventually proceed to a hypothyroid state. On physical examination, patients often have a moderately enlarged, nontender thyroid. Laboratory finding in all hypothyroid patients include elevated TSH with decreased concentrations of free T3 and T4.
Hashimoto's thyroiditis is associated with increased risk of thyroid lymphoma. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Autoimmune, WBRKeyword::Thyroid, WBRKeyword::Thyroiditis, WBRKeyword::Cancer, WBRKeyword::Hashimoto's thryoiditis, WBRKeyword::Endocrinology, WBRKeyword::Lymphoma |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |