Endocrine: Hashimoto thyroiditis: practice question

A Pathology 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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Pathology · Endocrine: Hashimoto thyroiditis

Sample item

A 40-year-old woman has a diffusely enlarged, firm, painless goitre and high anti-thyroid peroxidase antibodies. Fine-needle aspiration is performed. Which cytological finding is expected?

ADense fibrous tissue extending into surrounding neck structuresBHurthle cells with lymphocytes and plasma cellsCNuclear grooves with intranuclear pseudo-inclusionsDMultinucleated giant cells surrounding colloid fragments

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

The answer and the reasoning

B. Hurthle cells with lymphocytes and plasma cells

Hashimoto thyroiditis shows a dense lymphoplasmacytic infiltrate with germinal centres and follicles lined by oncocytic Hurthle cells that have abundant eosinophilic cytoplasm. It is autoimmune, mediated by CD8 T cells, CD4 T cells and anti-TPO and anti-thyroglobulin antibodies. Patients become hypothyroid and have a raised risk of thyroid lymphoma.

Option by option

A. Dense fibrous tissue extending into surrounding neck structures
Dense fibrosis extending beyond the capsule describes Riedel thyroiditis, with a woody, fixed gland.
B. Hurthle cells with lymphocytes and plasma cells (correct)
Correct. Hurthle cells with a lymphoplasmacytic infiltrate are the hallmark of Hashimoto thyroiditis.
C. Nuclear grooves with intranuclear pseudo-inclusions
Nuclear grooves and pseudo-inclusions describe papillary thyroid carcinoma.
D. Multinucleated giant cells surrounding colloid fragments
Giant cells around colloid describe subacute granulomatous (de Quervain) thyroiditis, which is painful with a raised ESR.

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.

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is B, Hurthle cells with lymphocytes and plasma cells. Hashimoto thyroiditis shows a dense lymphoplasmacytic infiltrate with germinal centres and follicles lined by oncocytic Hurthle cells that have abundant eosinophilic cytoplasm.

Why is "Dense fibrous tissue extending into surrounding neck structures" not the answer?

Dense fibrosis extending beyond the capsule describes Riedel thyroiditis, with a woody, fixed gland.

Why is "Nuclear grooves with intranuclear pseudo-inclusions" not the answer?

Nuclear grooves and pseudo-inclusions describe papillary thyroid carcinoma.

Why is "Multinucleated giant cells surrounding colloid fragments" not the answer?

Giant cells around colloid describe subacute granulomatous (de Quervain) thyroiditis, which is painful with a raised ESR.

What concept does this question test?

It tests Endocrine: Hashimoto thyroiditis in Pathology. It is autoimmune, mediated by CD8 T cells, CD4 T cells and anti-TPO and anti-thyroglobulin antibodies. Patients become hypothyroid and have a raised 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 Endocrine: Hashimoto thyroiditis?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology 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.