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Endocrine Exam 1 > 7 - Pathology of the Thyroid > Flashcards

7 - Pathology of the Thyroid Flashcards

1
Q

What pathology of the thyroid will this cover?

A
  • Hyperthyroidism
  • Hypothyroidism
  • Goiter
  • Thyroid neoplasms
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2
Q

Give a basic overview of the types of hyperthyroid

A

All hyperthyroidism is too much T3 or T4

  • Primary = problem with thyroid
  • Secondary = problem with pituitary
  • Tertiary = problem with TSH
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3
Q

What are the signs and symptoms of hyperthyroidism?

A

EMPHASIZED THIS

Hypermetabolism

  • Weight loss
  • Muscle atrophy
  • Heat intolerance (fanning themselves)
  • Increased appetite
  • Patients sweat (and skin feels moist)

Enhanced epinephrine effect

  • Anxiety
  • Fine fluttering
  • Easily agitated, can’t sit down
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4
Q

Describe the typical hyperthyroidism patient

A

EMPHASIZED THIS
- If you see a younger female patient with symptoms, especially if they are in cardiology for irregular heart beat, it might be atrial fibrillation from hyperthyroidism

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5
Q

What is lid lag?

A

KNOW THIS

  • “Lid lag” is a delay in downward movement of the upper eyelid as the patient looks down
  • It is enhanced by the ophthalmopathy of Graves disease
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6
Q

Describe the eyes of a hyperthyroidism patient

A

Very typical eyes
Lid lag, weak eye muscles and excess collagen in the eye all make the eyes protrude forward

We call this exophthalmos and it causes proptosis

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7
Q

What is myxedema?

A
  • Nodules confined to the anterior aspect of the legs (shins)
  • Edema of the legs
  • Usually seen in hypothyroidism, but can also be seen in hyperthyroidism sometimes
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8
Q

Describe the thyroid of a Graves’ patient

A

EMPHASIZED THIS

diffuse, symmetrical beefy red gland

** KNOW THIS WORD BY WORD **

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9
Q

What do you see at the molecular level?

A

KNOW SCALLOPING AND HYPERPLASTIC FOLLICLES WITH PAPILLARY INFOLDINGS *** –> This is Graves disease

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10
Q

Describe the signs and symptoms of hypothyroidism

A
  • Slowing of the mind and body –> Prime problem
  • Myxedema
  • Fatigue
  • Constipation
  • Menstrual irregularities
  • Weakness
  • Weight gain
  • Decreased memory and mental acuity
  • Facial and periorbital edema
  • ENLARGED tongue ***
  • Course, dry skin
  • Decreased metabolism
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11
Q

What was the symptom of hypothyroidism that was EMPHASIZED?

A

ENLARGED TONGUE
- Can see notches on the side of the tongue

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12
Q

What is cretinism?

A
  • Hypthyroidism presenting first in infancy or childhood
  • Leads to stunted growth, mental retardation, etc.
  • We screen for this at birth because it can be treated within 3 weeks of life to prevent problems
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13
Q

What is Hashimoto thyroiditis?

A

A common chronic progressive autoimmune thyroid disease

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14
Q

What does the thyroid of a Hashimoto’s patient look like?

A

EMPHASIZED THIS

  • Diffusely enlarged thyroid where the capsule is intact and well demarcated
  • The surface is PALE, YELLOW/TAN and FIRM ***

NOT beefy and red like in hyperthyroiditis

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15
Q

What are the signature cells seen in thyroid follicles of patients with Hashimoto thyroiditis (hypothyroidism)?

A

HURTHLE CELLS *****

  • If you see Hurthle cells, it means Hashimoto’s
  • It can happen in other disease states, but 90% of the time it is Hashimotos
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16
Q

Describe Hurthle cells

A
  • Abundant eosinophilic, granular cytoplasm
  • Metaplastic response (Metaplasia) due to ongoing injury
  • The normal low cuboidal follicular epithelials is injured

EMPHASIZED THIS

17
Q

What is De Quervian thyroiditis?

A

A PAINFUL, transient HYPERthyroidism that goes away by itself in a matter of weeks to months following an infection

Need to be able to recognize that it is not Graves disease even though T3/4 are high

18
Q

What causes De Quervian thyroiditis?

A

Viral cause

- Generally secondary to a viral infection by mumps, adenoviruses, echo, coxackie

19
Q

What is a Goiter?

A
  • A non-nodular enlargement of the thyroid gland

- Seen more commonly in females (8:1)

20
Q

What causes a Goiter?

A

EMPHASIZED THIS

  • The thyroid’s ability to produce thyroid hormone is impaired
  • The circulating levels of thyroid stimulating hormone (TSH) are very high because it is trying to signal T3/4 production
  • The most common cause of a goiter worldwide is IODINE deficiency ***
  • In the US, where the use of iodized salt is common, a goiter is more often due to the over- or underproduction of thyroid hormones or to nodules that develop in the gland itself
21
Q

What is a colloid goiter?

A
  • The precursor to a nodular goiter

- The follicles of the gland are enlarged and filled with colloid

22
Q

What is a nodular goiter?

A

Over time, the colloid goiter may become nodular

Many patients eventually develop toxic multinodular goiter

23
Q

How can you tell the difference between a goiter and a tumor?

A

CAPSULE - emphasized this!

  • A neoplasm will not have a capsule
  • A goiter will be encasulated
24
Q

What can a multinodular goiter result in?

A

A disease resembling Graves disease (hyperthyroidism) but without exopthalmos or dermatropathy
- You will see increase size and lobulation of the thyroid gland

25
Q

What is the gold standard for diagnosing a thyroid neoplasm?

A

Biopsy

26
Q

What is the difference between a “hot” neoplasm and a “cold” neoplasm?

A
  • Hot = the mass will accumulate increased amounts of radioiodine during a scan
  • Cold = the thryoid will not take up aditional radiolabeled iodine during a scan
27
Q

What are thyroid adenomas?

A

EMPHASIZED THIS

  • A neoplasm of the thyroid that does NOT have a tendency to become malignant
  • It is capsulated
  • It is a single structure
  • It is most common in female adults

KNOW THIS ***

28
Q

What are the four categories of thyroid cancers?

A
  • Papillary (65%) - majority won’t die
  • Follicular (25%)
  • Medullary (5%) - from parafollicular C cells
  • Anaplastic (5%) - almost all will die

PFMA (best to worst)

29
Q

What is a key feature of the first type of thyroid cancer? Papillary thyroid carcinoma (PTC)?

A

Orphan Annie eyes

  • Pathologists will see this
  • This is what the nucleus looks like

Intranuclear cytoplasmic inclusion
- You will also see intranuclear grooves which make it look like a coffee bean

Psammoma bodies

EMPHASIZED THIS

30
Q

What is a characteristic of follicular thyroid carcinoma?

A

EMPHASIZED THIS

  • Metastases to the lungs and bone
  • NO mets to the lymphatics
  • NO orphan annie ies or psammoma bodies
31
Q

Where does a medullary thyroid carcinoma originate from?

A

NEED TO KNOW

  • C cells, which are parafollicular cells
  • We do nor have good treatment for this kind of cancer
32
Q

How would you describe anaplastic carcinoma?

A

VERY ugly, both histoligcally and clinically

Almost all will die

Endocrine Exam 1 (18 decks)

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