Hashimoto Thyroiditis: The Daily PANCE Blueprint

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Hashimoto Thyroiditis: The Daily PANCE Blueprint

A 46-year-old woman reports several months of fatigue, cold intolerance, constipation, dry skin, and a 4-kg weight gain. On exam she has a firm, nontender, diffusely enlarged thyroid and a heart rate of 54/min with delayed relaxation of the deep tendon reflexes. Laboratory studies show an elevated TSH, a low free T4, and high titers of anti-thyroid peroxidase (anti-TPO) antibodies. Which of the following is the most likely diagnosis?

A. Graves disease
B. Hashimoto (chronic lymphocytic) thyroiditis
C. Subacute (de Quervain) granulomatous thyroiditis
D. Toxic multinodular goiter
E. Iodine-deficiency goiter

Answer and topic summary

The answer is B. Hashimoto (chronic lymphocytic) thyroiditis.

Hashimoto thyroiditis is the most common cause of hypothyroidism in iodine-sufficient regions. It is an autoimmune disease marked by a firm, nontender goiter, the laboratory picture of primary hypothyroidism (high TSH, low free T4), and positive anti-TPO antibodies — the hallmark serologic finding. Graves disease and toxic multinodular goiter cause HYPERthyroidism (low TSH). Subacute granulomatous (de Quervain) thyroiditis presents with a PAINFUL, tender thyroid after a viral illness and a transient hyperthyroid phase. Iodine-deficiency goiter is uncommon where salt is iodized and is not associated with anti-TPO antibodies.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Endocrinology ⇒ Diseases of the Thyroid Gland ⇒ Hypothyroidism

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