WBR0672

Author	[[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Serge Korjian)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathology
Sub Category	SubCategory::Endocrine
Prompt	[[Prompt::A 42-year-old Korean woman, with no significant past medical history, presents to the physician's office with complaints of excessive fatigue and weight gain. Upon further questioning, the patient reports she has recent developed constipation, hair loss, and somnolence. Physical examination is remarkable for a palpable thyroid mass. Following appropriate work-up, the patient is found to have elevated TSH, low FT4, and elevated levels of anti-thyroid peroxidase antibodies (anti-TPO). Which of the following conditions is known to be associated with the patient's disease?]]
Answer A	AnswerA::Non-Hodgkin's lymphoma
Answer A Explanation	AnswerAExp::Non-Hodgkin's lymphoma (NHL) is associated with Hashimoto's thyroiditis.
Answer B	AnswerB::Hodgkin's lymphoma
Answer B Explanation	AnswerBExp::Hodgkin's lymphoma is not associated with Hashimoto's thyroiditis.
Answer C	AnswerC::Acute myelogenous leukemia
Answer C Explanation	AnswerCExp::Acute myelogenous leukemia (AML) is not associated with Hashimoto's thyroiditis.
Answer D	AnswerD::Chronic myelogenous leukemia
Answer D Explanation	AnswerDExp::Chronic myelogenous leukemia (CML) is not associated with Hashimoto's thyroiditis.
Answer E	AnswerE::Chronic lymphocytic leukemia
Answer E Explanation	AnswerEExp::Chronic lymphocytic leukemia (CLL) is not associated with Hashimoto's thyroiditis.
Right Answer	RightAnswer::A
Explanation	[[Explanation::The patient is presenting with symptoms and signs consistent with Hashimoto's thyroiditis. She reports excessive fatigue, sleepiness, weight gain, cold intolerance, hair loss, and constipation - all of which are symptoms of hypothyroidism. Furthermore, physical examination confirms a thyroid pathology; and work-up makes the diagnosis of Hashimoto's thyroiditis most likely due to the presence of anti-TPO (positive in 90% of Hashimoto's thyroiditis cases). Hashimoto's thyroiditis is known to be associated with Non-Hodgkin's lymphoma (NHL). The most common form of thyroid NHL in patients with Hashimoto's thyroiditis is a low grade B-cell lymphoma of MALT type. Thyroid NHL is 4 times more common in women than in men, and up to 50% of the these patients have a history of Hashimoto's thyroiditis. The most common clinical manifestations are related to a rapidly the rapidly enlarging mass and include progressive goiter and compression symptoms. Educational Objective: Hashimoto's thyroiditis is associated with Non-Hodgkin's lymphoma. References: Miller, T. P., Dahlberg, S., Cassady, J. R., Adelstein, D. J., Spier, C. M., Grogan, T. M., & Fisher, R. I. (1998). Chemotherapy alone compared with chemotherapy plus radiotherapy for localized intermediate-and high-grade non-Hodgkin's lymphoma. New England Journal of Medicine, 339(1), 21-26.]]
Approved	Approved::Yes
Keyword	WBRKeyword::Hashimoto's thyroiditis, WBRKeyword::Hypothyroidism, WBRKeyword::Autoimmune diseases, WBRKeyword::Non-Hodgkin's lymphoma, WBRKeyword::Thyroid nodule
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