Question:easy
A 30-year-old woman presents with thyroid swelling. On investigation, her TSH level is elevated. Postoperative histology shows lymphocytic infiltration and Hurthle cells. The most probable diagnosis is?
A 30-year-old woman presents with thyroid swelling. On investigation, her TSH level is elevated. Postoperative histology shows lymphocytic infiltration and Hurthle cells. The most probable diagnosis is?
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High TSH plus germinal centres plus Hurthle cells in a young woman points to one autoimmune gland failure.
Updated On: Jun 23, 2026
- Graves disease
- Hashimoto's thyroiditis
- Follicular carcinoma
- Medullary carcinoma thyroid
Show Solution
The Correct Option is B
Solution and Explanation
Mnemonic anchor: Hashimoto equals Hurthle cells plus High TSH.
Read the labs first: TSH is elevated, so the gland is underactive. That single fact removes Graves disease, where TSH is suppressed because the gland is overdriven.
Read the histology: dense lymphocytic infiltrate with germinal centres and Hurthle (oxyphil) cells is the signature of chronic autoimmune thyroiditis. Cancers behave differently: follicular carcinoma is diagnosed by capsular or vascular invasion, and medullary carcinoma shows neuroendocrine C cells with amyloid stroma, neither of which is described.
Putting it together: a hypothyroid young woman with lymphocytic, Hurthle-cell-rich thyroid tissue has Hashimoto's thyroiditis, the leading cause of acquired hypothyroidism. Anti-TPO antibodies would confirm it clinically.
Reference: standard endocrine pathology.
Read the labs first: TSH is elevated, so the gland is underactive. That single fact removes Graves disease, where TSH is suppressed because the gland is overdriven.
Read the histology: dense lymphocytic infiltrate with germinal centres and Hurthle (oxyphil) cells is the signature of chronic autoimmune thyroiditis. Cancers behave differently: follicular carcinoma is diagnosed by capsular or vascular invasion, and medullary carcinoma shows neuroendocrine C cells with amyloid stroma, neither of which is described.
Putting it together: a hypothyroid young woman with lymphocytic, Hurthle-cell-rich thyroid tissue has Hashimoto's thyroiditis, the leading cause of acquired hypothyroidism. Anti-TPO antibodies would confirm it clinically.
Reference: standard endocrine pathology.
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