Karnataka PGET Surgery MCQ Answer 26

The correct answer is D

The presence of thyroid autoantibodies, typically anti-TPO and also anti-Tg antibodies, delineates the cause of hypothyroidism as Hashimoto thyroiditis or its variant. However, 10-15% of patients with Hashimoto thyroiditis may be antibody negative.

Perform fine-needle aspiration of any dominant or suspicious thyroid nodules in order to exclude malignancy or presence of a thyroid lymphoma in fast-growing thyroid goiters. Hashimoto thyroiditis is a histologic diagnosis. Typically, the thyroid gland shows diffuse lymphocytic and plasma cell infiltration with formation of lymphoid follicles from follicular hyperplasia and damage to the follicular basement membrane. Atrophy of the thyroid parenchyma is usually evident. Correlation with the presence of thyroid autoantibodies, namely anti-TPO and also anti-Tg, is helpful for confirming the definite diagnosis.

The treatment of choice for Hashimoto thyroiditis (or hypothyroidism of any cause) is thyroid hormone replacement. The drug of choice is orally administered levothyroxine sodium, usually for life.

• Indications for surgery

• A large goiter with obstructive symptoms such as dysphagia, voice hoarseness, and stridor from extrinsic obstruction to airflow: Evaluate patients with these symptoms with a barium swallow study and pulmonary function tests, including flow volume loops and a neck CT scan.

• Presence of a malignant nodule, as found by cytologic examination by fine-needle aspiration.

• Presence of a lymphoma diagnosed on fine-needle aspiration: Thyroid lymphoma responds very well to radiotherapy and is the treatment modality of choice in this situation.

• Cosmetic reasons for unsightly large goiters

Category: Karnataka PGET 2007 MCQs