This was a 49-year-old woman who complained during her yearly physical examination of tiredness and difficulty concentrating. She attributed these symptoms to stress at work. She had gained weight over the last year and despite warm weather, she felt chilled without a sweater. Family history was significant for hypothyroidism in her mother and older sister. On physical examination she had a pulse of 58 bpm and a blood pressure of 138/88 mm Hg. Examination of her neck disclosed a small an enlarged thyroid gland with a palpable pyramidal lobe and a firm, bosselated texture. Serum taken at this time demonstrated a total T4 of 7.0 mcg/dL and a TSH of 22.0 mcIU/ml. In addition, antithyroglobulin antibodies were positive at 1:640 was markedly elevated and antimicrosomal antithyroid peroxidase antibodies were positive at 1:5120. These results supported the clinical impression of hypothyroidism; also, the texture of her thyroid gland and a positive family history suggested an autoimmune etiological factor. She was referred to an endocrinologist for further evaluation; however, before beginning treatment she died suddenly from a ruptured berry aneurysm of the middle cerebral artery. == Autopsy Findings == At autopsy, significant subarachnoid hemorrhage from the ruptured berry aneurysm was documented. In addition, the thyroid gland was mildly enlarged and firm. On cut section the tissue was slightly pale.

File:IPLab6Hashimoto2IPLab6Hashimoto3.jpg|This is a low-power photomicrograph of thyroid from this case. Note that the tissue is more cellular than one would expect and there does not appear to be normal colloid-filled blue spaces in this gland. File:IPLab6Hashimoto3.jpg|This is a higher-power photomicrograph of thyroid from this case. Note the large number of blue-staining inflammatory cells in this tissue. These blue cells appear to be forming germinal centers. Some residual thyroid gland tissue can be seen in this section (arrows). File:IPLab6Hashimoto4.jpg|This is another view of thyroid gland filled with inflammatory cells forming germinal centers (arrows). File:IPLab6Hashimoto5IPLab6Hashimoto5b.jpgJPG|This is a higher-power photomicrograph of thyroid from this case showing the inflammatory cells and the residual thyroid tissue. File:IPLab6Hashimoto6.jpg|This is another higher-power photomicrograph of thyroid from this case showing the inflammatory cells and the residual thyroid tissue(arrow).

* [http://peir.path.uab.edu{{SERVER}}/library/index.php?/tags/15-endocrine/140-thyroid/141-lymphocytic_thyroiditis PEIR Digital Library: Lymphocytic Thyroiditis Images]