WBR0518
| Author | [[PageAuthor::Gonzalo A. Romero, M.D. [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 2 CK |
| Main Category | MainCategory::Internal medicine |
| Sub Category | SubCategory::Endocrine, 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::Incorrect. 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::Correct. Riedel's thyroiditis can involve mediastinal and retroperitoneal fibrosis.]] |
| Answer C | AnswerC::Thyroid storm |
| Answer C Explanation | [[AnswerCExp::Incorrect. 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::Incorrect. 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::Incorrect.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:
Educational Objective: |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Riedel thyroiditis |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |