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thyroid Q

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8 Posts

jean robert
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02/17/08 - 08:11 PM

A 30-year-old woman from Barcelona has noted enlargement of her neck over the past 4 months. On physical examination, she has a diffusely enlarged thyroid that is not painful to palpation. Her TSH level is 0.2 mU/L. A subtotal thyroidectomy is performed and histologically the tissue shows follicles with papillary infoldings lined by tall columnar cells. Which of the following is the most likely diagnosis?

A Subacute granulomatous thyroiditis

B Papillary carcinoma

C Multinodular goiter

D Hashimoto thyroiditis

E Graves disease

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pr20
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02/17/08 - 08:39 PM

D.Hashimoto thyroiditis

jean robert
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02/17/08 - 09:47 PM

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pr20
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02/17/08 - 10:35 PM

E.Grave's disease.
Seeing the word"papillary infoldings",i first thought of papillary carcinoma.But papillary carcinoma usually presents as painless nodule instead of diffuse thyroid swelling.I went with hashimoto disease bcas i thought the histological description as graffian follicles.
Yep its my mistake i shd have thought carefully about TSH levels.This time iam going with choice E bcas thyroid cancers usually have normal TSH levels.
Grave's disease presents as diffuse painless thyroid swelling with TSH levels suppressed(due to hyperthyroidism).Iam not sure with the histological findings of grave's disease but hope iam right this time atleast confused

jean robert
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02/17/08 - 10:46 PM

pr20 wrote:
E.Grave's disease.
Seeing the word"papillary infoldings",i first thought of papillary carcinoma.But papillary carcinoma usually presents as painless nodule instead of diffuse thyroid swelling.I went with hashimoto disease bcas i thought the histological description as graffian follicles.
Yep its my mistake i shd have thought carefully about TSH levels.This time iam going with choice E bcas thyroid cancers usually have normal TSH levels.
Grave's disease presents as diffuse painless thyroid swelling with TSH levels suppressed(due to hyperthyroidism).Iam not sure with the histological findings of grave's disease but hope iam right this time atleast confused

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jean robert
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02/17/08 - 10:49 PM

E CORRECT. Diffuse hyperplasia is typical for Graves disease. The TSH is low from negative feedback from increased thyroid hormone production.

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Ig F
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02/18/08 - 04:11 PM

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new_n_lost
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02/27/08 - 06:27 AM

Good One!!

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