Thyroid: lymphoma: practice question

A General Surgery 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 Surgery · Thyroid: lymphoma

Sample item

A 62-year-old woman with long-standing Hashimoto thyroiditis develops rapid enlargement of the thyroid over 6 weeks, with dysphagia. FNAC suggests a lymphoid infiltrate but is not conclusive. What is the best next step?

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

The answer and the reasoning

C. Core needle biopsy with immunohistochemistry and flow cytometry

Hashimoto thyroiditis increases the risk of primary thyroid lymphoma, usually diffuse large B-cell or MALT type, which presents as a rapidly enlarging goitre. FNAC often cannot subtype lymphoma, so core or open biopsy with immunophenotyping is needed. Lymphoma is treated with chemoradiotherapy rather than radical surgery.

Option by option

  • A. Total thyroidectomy straight away

    Radical surgery is not the treatment for lymphoma and could be unnecessary.

  • B. Radioiodine therapy

    Radioiodine would not be effective against lymphoma, which does not concentrate iodine.

  • C. Core needle biopsy with immunohistochemistry and flow cytometry (correct)

    Correct. Architecture and immunophenotype are needed to diagnose and subtype lymphoma.

  • D. Increase the levothyroxine dose

    Higher levothyroxine will not control a malignant lymphoproliferative process.

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 Surgery question

What is the answer to this General Surgery question?

The best answer is C, Core needle biopsy with immunohistochemistry and flow cytometry. Hashimoto thyroiditis increases the risk of primary thyroid lymphoma, usually diffuse large B-cell or MALT type, which presents as a rapidly enlarging goitre.

Why is "Total thyroidectomy straight away" not the answer?

Radical surgery is not the treatment for lymphoma and could be unnecessary.

Why is "Radioiodine therapy" not the answer?

Radioiodine would not be effective against lymphoma, which does not concentrate iodine.

Why is "Increase the levothyroxine dose" not the answer?

Higher levothyroxine will not control a malignant lymphoproliferative process.

What concept does this question test?

It tests Thyroid: lymphoma in General Surgery. FNAC often cannot subtype lymphoma, so core or open biopsy with immunophenotyping is needed. Lymphoma is treated with chemoradiotherapy rather than radical surgery.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Thyroid: lymphoma?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.