Sandbox:DDx HEENT

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  • 15-30 yo women
  • Fatigue, weight gain, cold intolerance, constipation, myopathy, depression, menorrhagia, and infertility
  • Nontender mild neck swelling
  • Puffy face, bradycardia, and dry skin
  • Decreased T3/T4 and increased TSH
  • Anti-thyroid peroxidase antibodies
  • Elevated cholesterol levels
  • Hypoechoic thyroid gland with coarse or "micronodular" echotexture on U/S
  • Increased vascularity of the gland
  • Extensive T cell lymphocytic infiltrate
  • Nuclear clearing
  • Germinal center formation
  • Hürthle cells and giant cells
  • Fibrosis


  • HLA-DR5
  • CTLA4
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