Endocrinology: Hashimoto thyroiditis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Endocrinology: Hashimoto thyroiditis

Sample item

A 40-year-old woman has a firm goitre, fatigue and TSH of 18 mU/L. Biopsy would show which finding?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Lymphocytic infiltrate with germinal centres and Hurthle cells

Hashimoto thyroiditis is autoimmune with anti-TPO and anti-thyroglobulin antibodies and shows lymphocytic infiltration, germinal centres and oncocytic Hurthle cells. It is the commonest cause of hypothyroidism in iodine-sufficient regions. Patients have an increased risk of thyroid lymphoma.

Option by option

  • A. Orphan Annie nuclei

    Orphan Annie nuclei suggest papillary carcinoma.

  • B. Granulomatous inflammation with giant cells

    Giant cell granulomas indicate subacute thyroiditis.

  • C. Amyloid deposits

    Amyloid suggests medullary carcinoma.

  • D. Lymphocytic infiltrate with germinal centres and Hurthle cells (correct)

    Correct. This is the typical histology.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Lymphocytic infiltrate with germinal centres and Hurthle cells. Hashimoto thyroiditis is autoimmune with anti-TPO and anti-thyroglobulin antibodies and shows lymphocytic infiltration, germinal centres and oncocytic Hurthle cells.

Why is "Orphan Annie nuclei" not the answer?

Orphan Annie nuclei suggest papillary carcinoma.

Why is "Granulomatous inflammation with giant cells" not the answer?

Giant cell granulomas indicate subacute thyroiditis.

Why is "Amyloid deposits" not the answer?

Amyloid suggests medullary carcinoma.

What concept does this question test?

It tests Endocrinology: Hashimoto thyroiditis in General Medicine. It is the commonest cause of hypothyroidism in iodine-sufficient regions. Patients have an increased risk of thyroid lymphoma.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Endocrinology: Hashimoto thyroiditis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.