WBR0142
| 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::This patient has Hashimoto’s disease. It does not increase the risk of developing medullary carcinoma of the thyroid.]] |
| 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. The diagnosis of hypothyroidism was further confirmed by the positive laboratory test for antithyroid peroxidase antibodies. Hashimoto's thyroiditis is associated with increased risk of thyroid lymphoma.
Educational objective: Hashimoto's thyroiditis is considered a risk factor for the development of thyroid lymphoma. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Autoimmune, WBRKeyword::Thyroid, WBRKeyword::Thyroiditis, WBRKeyword::Cancer, WBRKeyword::Hashimoto's thryoiditis, WBRKeyword::Endocrinology |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |