Hashimoto thyroiditis Quiz: Ace Your Exams

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A 44-year-old woman comes to the PA complaining of a 12-lb weight gain over the past two months. The patient is a vegetarian and her diet consists of fruits, vegetables, and grains. She has had no increase in appetite. The patient also complains of excessive fatigue but attributes it to her stressful job as a nurse. Three months ago, she experienced recurrent episodes of anxiety, palpitations, and unintentional weight loss of 8-lb; these episodes resolved on their own. Temperature is 37.0°C (98.6°F), pulse is 52/min, blood pressure is 124/88 mm Hg, and BMI is 22 kg/m2. Physical examination reveals cold, dry skin and thinning hair on the scalp. Neck palpation reveals no tenderness or masses. There is delayed tendon reflex relaxation in the lower extremities. Diagnostic testing shows the following:  

Laboratory value  
Result
Reference Range  
Sodium
137 mEq/L  
136-146 mEq/L  
Potassium  
4.8 mEq/L  
3.5-5 mEq/L  
Chloride
99 mEq/L  
95-105 mEq/L  
Glucose  
89 mg/dL  
70-110 mg/dL  
ESR
9 mm/hr  
0-20 mm/hr  
TSH
7.1 μU/mL  
0.5-5 μU/mL  
Anti-thyroid peroxidase  
Positive  
Negative

Biopsy of this patient’s thyroid will most likely reveal which of the following?  

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