Sandbox:DDx HEENT

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  • 40-60 yo women
  • Weight loss, heat intolerance, diarrhea, insomnia, hair loss and palpitations
  • Ophthalmopathy
  • Diffusely enlarged, symmetric, nontender goiter
  • Lid lag and exophthalmus
  • Pretibial myxedema
  • Moist warm skin
  • Decreased TSH
  • Elevated T3 and T4
  • Positive TSH-receptor antibodies
  • Plump follicular cells with eosinophilic cytoplasm
  • Hyperplastic follicles with papillary epithelial infoldings
  • Colloid 'scalloping' at the apical membrane


  • BRAF gene mutation
  • p53 gene mutation
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