This patient was a 50-year-old male with a prostatic mitral valve who was receiving long-term antibiotics for endocarditis. Died of acute cardiac failure. At autopsy, a large vegetation/thrombus completely obstructed the prosthetic mitral valve mechanism. Additional key findings are pictured. Your job is to deduce the chain of events that led to the findings pictured below.
![](https://static.wixstatic.com/media/c679ab_f54a9b3a0b5046508276ba70b61c31c2~mv2.jpg/v1/fill/w_147,h_110,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/c679ab_f54a9b3a0b5046508276ba70b61c31c2~mv2.jpg)
Above: H&E from mitral vegetation
![](https://static.wixstatic.com/media/a27d24_6ba55417b056438598a6388140d8bd66~mv2.jpg/v1/fill/w_147,h_124,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/a27d24_6ba55417b056438598a6388140d8bd66~mv2.jpg)
Above: Gross of thyroid lobe and cute surface
![](https://static.wixstatic.com/media/c679ab_2402901734a84382a5cf4872751a8f25~mv2.jpg/v1/fill/w_147,h_110,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/c679ab_2402901734a84382a5cf4872751a8f25~mv2.jpg)
Above: H&E photomicrograph of thyroid gland, high power