Where is the thyroid in this elderly patient?

This 60 year old man underwent sonography of the thyroid. Ultrasound images are shown below:

Severe atrophy of the thyroid in a 60-year-old male with long-standing Hashimoto's thyroiditis:

Patient Information:

* Age: 60

* Sex: Male

* Diagnosis: Hashimoto's thyroiditis

* Presenting Symptoms: Fatigue, weight gain, dry skin, hair loss

Physical Examination:

=Thyroid gland is not palpable

=No goiter

=No lymphadenopathy

Laboratory Tests:

* TSH: 100 mIU/L (normal range: 0.4-4.0 mIU/L)

* Free T4: 0.1 ng/dL (normal range: 0.9-1.8 ng/dL)

* Antithyroid peroxidase antibodies (TPOAbs): 1000 IU/mL (normal range: <35 IU/mL)

Imaging Studies:

Thyroid ultrasound: No thyroid tissue visualized.

Ultrasound imaging findings of the case:

* The thyroid gland was not visualized on ultrasound imaging.

* The thyroid bed was unremarkable. Possible fibrotic and adipose tissue seen in the thyroid bed. This in all likelihood is the residual atrophied thyroid tissue. 

* There was no evidence of lymphadenopathy.

The absence of thyroid tissue on ultrasound imaging is consistent with severe atrophy of the thyroid gland. The unremarkable thyroid bed and the absence of lymphadenopathy suggest that the atrophy is not due to a malignancy.

Severe atrophy of the thyroid gland can be caused by a variety of conditions, including Hashimoto's thyroiditis, Riedel's thyroiditis, and post-thyroidectomy hypothyroidism. In the case of this patient, the history of Hashimoto's thyroiditis makes this the most likely diagnosis.

Severe atrophy of the thyroid gland can lead to hypothyroidism, which can cause a variety of symptoms, including fatigue, weight gain, dry skin, hair loss, and cold intolerance. Levothyroxine replacement therapy is the standard treatment for hypothyroidism and can help to relieve these symptoms.

Diagnosis:

Severe atrophy of the thyroid gland due to Hashimoto's thyroiditis

Treatment:

* Levothyroxine replacement therapy

Prognosis:

Good with appropriate treatment

Points to Consider:

1. Hashimoto's thyroiditis is an autoimmune disease that causes inflammation and destruction of the thyroid gland.

2. Severe atrophy of the thyroid gland can lead to hypothyroidism, which can cause a variety of symptoms, including fatigue, weight gain, dry skin, hair loss, and cold intolerance.

3. Levothyroxine replacement therapy is the standard treatment for hypothyroidism.

4. With appropriate treatment, patients with severe atrophy of the thyroid gland due to Hashimoto's thyroiditis can have a good prognosis.

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