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On physical examination she had an enlarged thyroid gland with a firm, bosselated texture. Serum TSH was markedly elevated and antithyroid peroxidase antibodies were positive. 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; however, before beginning treatment she died suddenly from a ruptured berry aneurysm.
== Images ==
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File:IPLab6Hashimoto1.jpg|This is a gross photograph of thyroid gland taken at autopsy. The gland is only slightly enlarged and has a firm texture.
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).
File:IPLab6Hashimoto7.jpg|This is a high-power photomicrograph showing the inflammatory cells infiltrating into the residual thyroid tissue (arrows).
File:IPLab6Hashimoto8.jpg|This is a high-power photomicrograph showing the lymphocytes and plasma cells surrounding the thyroid gland epithelium.
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