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NBME 24 Answers

nbme24/Block 1/Question#21 (25.4 difficulty score)
A 35-year-old woman comes to the physician ...
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gubernaculum  also just an FYI, her achilles reflex symptom is called Woltman Sign and can be seen in many cases of hypothyroidism +2  
ruready4this  got the right answer but does anyone know why a lingual thyroid would cause hypothyroidism instead of hyperthyroidism? because I know patients who have a lingual thyroid removed are at risk of hypothyroidism +1  
therealslimshady  Probably not scientifically accurate, but the body is like, hey, lingual thyroid, you're in the wrong place, you don't get to grow! Hypothyroidism ensues. Plus I don't think you'd be able to swallow if you had a normal-sized thyroid literally inside your throat. +  
qiss  @ruready4this, she probably has hypothyroidism because her lingual thyroid isn't functioning enough like a normal sized thyroid. The question mentioned no palpable thyroid gland, as in the lingual thyroid is doing all of the work due to an absent thyroid gland in the neck. This is actually the reason why patients who have a lingual thyroid removed are at risk for hypothyroidism- once you remove it, you have zero tissue producing thyroxine. +  

This is a case of lingual thyroid, a persistence of thyroid tissue at the base of the tongue due to failure of migration.