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15 Endocrine > 15.3-7 Thyroid > Flashcards

15.3-7 Thyroid Flashcards

1
Q

Thyroid storm

-clinical presentation (3)

A
  1. arrhythmia
  2. hyperthermia
  3. vomiting with hypovolemic shock
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1
Q

How does thyroid hormone affect gut motility?

A

Low TH: constipation

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2
Q

Graves disease

-histology findings (2)

A
  1. irregular follicles (some with hyperplasia) with ‘scalloped colloid’
  2. chronic inflammation
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2
Q

Thyroid storm

-tx (3)

A

3 P’s

  1. propylthiouracil (blocks peroxidase and peripheral conversion of T4 to T3)
  2. Propranolol–beta blockers
  3. Prednisone–steroids
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2
Q

Medullary carcinoma, thyroid

  • proliferation of what cells?
  • clinical presentation
  • histology
A
  • prolifereation of parafollicular C cells (neuroendocrine cells, secrete calcitonin)
  • high calcitonin can lead to hypocalcemia

Histology: ‘localized amyloidosis’–Calcitonin often deposits within tumor as amyloid (pink). So, on FNA you see sheets of malignant cells in an amyloid stroma.

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3
Q

What are the 4 carcinomas to know that spread by blood, not lymph

A
  1. Renal cell carcinoma
  2. hepatic cell carcinoma
  3. follicular carcinoma
  4. choriocarcinoma
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4
Q

Follicular adenoma, thyroid

  • describe it
  • histology
A
  • benign proliferation of follicles surrounded by fibrous capsule (you see follicles within the tumor itself)
  • may secrete TH
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5
Q

Pt presents with a tender thyroid with signs of hyperthyroidism

  • think what?
  • ask what on history
A
  • subacute granulomatous (De Quervain) thyroiditis, follows a viral infection
  • produces transient hyperthyroidism and can progress to hypothyroidism (but usu self limiting)
  • ask about recent viral infection
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6
Q

Follicular carcinoma, thyroid

  • what is unique about its metastic spread?
  • gross appearance
A
  • it’s a carcinoma that spreads by blood instead of lymph (one of 4 to know)
  • malignant proliferation of follicles surrounded by fibrous capsule (just like adenoma) but with invasion through the capsule.
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7
Q

Cretinism

-symptoms (3)

A
  1. mental retardation
  2. short stature with skeletal abnormalities, coarse facial features, enlarged tongue
  3. umbilical hernia
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7
Q

what neoplasias?

MEN 1

MEN 2A

MEN 2B

A

PPP–pituitary, pancreatic endocrine, parathyroid

MPP–medullary thyroid, pheo, parathyroid

MPN–medullary thyroid, pheo, neuroma

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8
Q

MEN 2A and MEN2B

  • assoc with what genetics
  • inheritance?
A
  • RET mutation in MEN 2A and 2B (if you detect this, remove thyroid)
  • auto dom, “all MEN are dominant”
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9
Q

Graves disease

-Tx (3)

A
  1. beta blockers
  2. thioamid (blocks peroxidase)
  3. radioiodine ablation
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9
Q

Myxedema

  • symptoms based on what 2 general problems
  • characteristic (high yield) symptoms (2)
A

Term is synonymous with Hypothyroidism in older children, adults

  1. decreased basal metabolic rate
  2. decreased sympathetic activity

myxedema (accumulation of glycosaminoglycans in skin/soft tissue):

  1. deepening of voice
  2. large tongue
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9
Q

Hypothyroidism is called what in:

  1. infants, children
  2. older children, adults
A
  1. Cretinism
  2. Myxedema
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9
Q

Subacute Granulomatous (De Quervain) thyroiditis

  • cause
  • clinical presentation
A
  • granulomatous thyroiditis that follows a viral infection
  • presents as a tender thyroid with transient hyperthyroidism (De QuerVAIN–PAIN)
  • self-limited; 15% of time, progresses to hypothyroidism
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9
Q

Mother giving birth to child experiences hypovolemic shock, vomiting, arrythmias, hyperthermia.

-what to suspect?

A

Think thyroid storm, in women with Grave’s disease

-stress-induced catecholamine and hormone release

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11
Q

dyshormonogenetic goiter

-most common involves what enzyme

A
  • congenital defect in TH production
  • most commonly involves thyroid peroxidase
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12
Q

How does TH affect glucose levels?

A

TH increases gluconeogenesis, glycogenolysis

-so, hyperglycemia in hyperthyroidism

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12
Q

Graves disease

-lab findings (4)

A
  1. high total T4
  2. low TSH
  3. hypocholesterolemia
  4. hyperglycemia
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13
Q

Pt presents with nontender thyroid with throat obstruction.

-think what 2 things, and how to differentiate?

A

Think 2 things:

  1. Riedel fibrosing thyroiditis–patients are younger (40s), no malignant cells
  2. anaplastic carcinoma–patients are older
15
Q

Pt presents with thyroid nodule

-what test to do next to dx?

A
  1. 131 radioactive uptake study:
    - increased uptake (‘hot nodule’) is seen in Graves or nodular goiter
    - decreased uptake (‘cold nodule’) is seen in adenoma/carcinoma. Do biopsy! (FNA–fine needle aspiration)
16
Q

How are cholesterol levels affected by thyroid hormone?

-mech

A

increased TH increases LDL receptor expression, therefore lowering blood cholesterol.

16
Q

Multinodular goiter

  • cause
  • complication
A
  • enlarged thyroid gland with multiple nodules
  • due to relative iodine deficiency
  • Toxic goiter: rarely, regions can become TSH-independent, leading to T4 release and hyperthyroidism
18
Q

Graves disease

  • what is a potentially fatal complication?
  • mech
  • when does it occur?
A
  • Thyroid storm
  • elevated catecholamines and massive hormone excess, usu in response to stress (eg surgery, childbirth)
19
Q

What thyroid congenital abnormalities?

  1. mass at base of tongue
  2. mass at anterior of neck
A
  1. lingual thyroid
  2. thyroglossal duct cyst
21
Q

Cretinism

-causes include (4)

A
  1. iodine deficiency
  2. maternal hypothyroidism during early pregnancy
  3. thyroid agenesis
  4. dyshormonogenetic goiter
23
Q

Pt presents with thyroid mass and tetany, muscle spasms

-think what

A

Medullary carcinoma–hypocalcemia from calcitonin release from parafollicular C cells

25
Q

Hypothyroidism with tender thyroid vs nontender thyroid

-think what?

A
  • tender thyroid: subacute granulomatous (de quervain) thyroiditis
  • nontender: Riedel fibrosing thyroiditis

(‘hard as wood’)

26
Q

TH functions

A

4 B’s

Basal metabolic rate–increased

B1-adrenergic–increased

  • Brain maturation
  • Bone growth–increased
28
Q

Follicular carcinoma, thyroid

  • histology
  • what can it be confused with? and how to differentiate in that case?
A
  • proliferation of follicles inside tumor, surrounded by fibrous capsule
  • histologically looks just like follicular adenoma
  • therefore, FNA cannot distinguish between the 2. Must examine the tumor grossly to see if there is invasion through the capsule (indicating follicular carcinoma)
29
Q
  1. thyroglossal duct cyst
  2. lingual thyroid
    - clinical presentation (each)
A
  1. anterior neck mass
  2. mass at base of tongue
30
Q

propylthiouracil

  • mech (2 effects)
  • tx for what
A
  1. blocks peroxidase–(oxidation, organification, and coupling steps of TH synthesis)
  2. peripheral conversion of T4 to T3
    - block thyroid funcion (eg thyroid storm)
30
Q

Riedel Fibrosing Thyroiditis

  • mech
  • clinical presentation
A
  • chronic inflammation with extensive fibrosis of the thyroid gland
  • presents as nontender thyroid gland (hard as wood) with hypothyroidism
  • fibrosis may extend to involved local structures (eg airway)
31
Q

Grave’s disease

  • mech
  • classic population
A
  • IgG stimulates TSH receptor (type 2 HSR)
  • women 20-40
32
Q

Pt presents with a thyroid mass that is not painful, along with increasing difficulty eating and breathing

-think what?

A
  1. Riedel’s fibrosing thyroiditis (mid age)
  2. anaplastic carcinoma of thyroid (elderly)
    - differentiate by age. biopsy will reveal dx
34
Q

Hashimoto’s thyroiditis

-histology (3 things)

A
  1. chronic inflammation
  2. germinal centers
  3. Hurthle cells (pink–eosinophilic metaplasia of cells that line follicles)
35
Q

Exophthalmos and Pretibial myxedema:

-mech

A
  • seen in Grave’s disease
  • fibroblasts behind orbit and in shin have TSH receptors and react to IgG against TSH
  • TSH actvation leads to glycosaminoglycan deposition, leading to edema

(‘dough like’ consistency)

36
Q

Hashimoto’s thyroiditis

  • clinical symptoms
  • TH lab levels
  • what Ab?
A
  • presents initially as hyperthyroidism (due to follicle damage)
  • progresses to hypothyroidism (low T4, high TSH)
    1. antithroglobulin Ab
    2. antithyroid peroxidase Ab
37
Q

Pt initially presents with signs of hyperthyroidism, then now with signs of hypothyroidism

-think what?

A
  1. Hashimoto’s thyroiditis–can present initially with hyperthyroidism b/c of follicle damage–release of TH
  2. also think De Quervain’s thyroiditis–presents with transient hyperthyroidism and can progress (rarely) to hypothyroidism
38
Q

Grave’s disease

-clinical symptoms (3)

A
  1. hyperthyroidism
  2. diffuse goiter
  3. exophthalmos, pretibial myxedema (‘dough like’ consistency)
    - fibroblasts behind orbit and overlying the shin express TSH receptor. TSH activation results in glycosaminoglycan buildup
39
Q

What to do if you suspect MEN in your pt?

A
  • test for RET mutation (for MEN 2A/2B)
  • if positive, remove thyroid gland prophylactically to prevent medullary carcinoma
41
Q

Papillary carcinioma, thyroid

-histology (3)

A

Papillae lined by cells with

  1. ‘Orphan Annie eye’ nuclei (empty, white nuclei)
  2. nuclear grooves
  3. Papillae also have psammoma bodies (Ca+ layering
42
Q

Papillary carcinoma, thyroid

  • prevalence among thyroid carcinoma
  • assoc with what major risk factor
A
  • most common thyroid carcinoma (80%)
  • exposure to ionizing radiation in childhood (classic: pt had face/neck irradiated as child for acne)
44
Q

What is the specific biopsy procedure for thyroid?

A

FNA–fine needle aspiration

-needle must be thin, as thyroid bleeds easily

45
Q

Thyroid cancer:

  • all malignant types (4)
  • nonmalignant type (1)
  • which is most common
A

PFA-M

all carcinomas:

Papillary (80%)

Follicular

Anaplastic

Medullary

-follicular adenoma (benign)

47
Q

Thyroglossal cyst

-etiology, embryology

A
  • cystic dilation of thyroglossal duct remnant
  • thyroid develops at base of tongue, then travels along the thyroglossal duct to anterior neck
  • thyroglossal duct normally involutes; however, a persistent duct can undergo cystic dilation
48
Q

Toxic goiter

A
  • rare complication of multinodular goiter, caused by iodine deficiency
  • rarely, nodules can become TSH-independent and secrete T4
49
Q

Hashimoto’s thyroiditis

  • assoc with what genetics
  • increased risk for what complication
A
  • HLA DR5
  • increased risk of B cell lymphoma (presents as enlarging thyroid gland late in Hashimoto’s disease course)
50
Q

Anaplastic carcinoma, thyroid

  • what is it, population
  • prognosis
  • clinical presentation
A
  • undifferentiated malignant tumor, usu in elderly
  • poor prognosis, highly malignant
  • presents similar to Riedel’s fibrosing thyroiditis–nontender thyroid mass that invades local anatomy. can cause dysphagia or respiratory compromise
51
Q

Myxedema (hypothyroidism)

  • most common causes (2)
  • other causes include (2)
A
  1. Hashimoto’s thyroiditis
  2. iodine deficiency
  3. drugs (eg lithium)
  4. surgery/radioablation
52
Q

Papillary carcinioma, thyroid

-prognosis

A

excellent. survival >95%

often spreads to cervical lymph nodes

15 Endocrine (7 decks)

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