B6-061 Thyroid Disease Flashcards
TSH will be […] in hypothyroidism
increased
**trying to compensate
pretibial nonpitting edema is associated with
longstanding hypothyroidism
hypothyroidism due to pituitary or hypothalamic failure is
secondary
two main types of primary hypothyroidism
-cretinism (peds)
-myxedema (adults)
maternal T3/T4 is necessary for fetal […] development
brain
**damage to fetal brain is most severe when maternal T3/4 is low before fetal thyroid becomes active
most common cause of congenital primary hypothyroidism worldwide
iodine deficiency
most common cause of primary hypothyroidism in US adults
Hashimoto
goiterogens [2]
PTU
iodide
**suppress T3/T4 synthesis
inhibits oxidation of iodide and peripheral deiodination of T4 into T3
PTU
inhibits proteolysis of thyroglobulin
iodide
CD 8 T cell mediated destruction of the thyroid
Hashiomotos
what antibodies are seen in Hashimoto’s?
anti-thyroglobulin
anti-thyroid peroxidase
Hashimotos may initially present with transient […]
hyperthyroidism
Hashimotos increases the risk of [3]
B cell lymphoma
thyroid cancers
other autoimmune disease
Hurthle cells
lymphoid aggregates with germinal centers
Hashimotos
self-limited disease preceded by viral infection
may have transient hyperthyroidism
painless goiter
subacute lymphocytic thyroiditis
painful goiter
transient hyperthyroidism
granulomatous (de Quervain) thyroiditis
jaw pain
very tender thyroid
granulomatous (de Quervain) thyroiditis
granulomatous inflammation on histology
granulomatous (de Quervain) thyroiditis
slowly enlarging
hard, fixed, nontender mass
Riedel thyroiditis
IgG4 related disease
Riedel thyroiditis
**in general, IgG4 is associated with fibrosis
thyroid replaced with fibrous tissue and inflammatory infiltrate on histology
Riedel
staring gaze, eyelid lag, proptosis
long standing hyperthyroidism (Graves)
pituitary tumor secreting TSH is […] hyperthyroidism
secondary
primary hyperthyroidism is caused by
thyrotoxicosis
thyrotoxicosis occurring due to diffuse hyperplasia
Graves
factitious hyperthyroidism is caused by
exogenous thyroid intake
antibodies associated with Graves disease [2]
thyroid stimulating antibody
TSH-R blocking antibody
infiltrative ophthalmopathy due to lymphocytes, edema, matrix, and fat deposition behind the eye
Graves disease
hyperthyroidism
exopthalmus
dermopathy (pretibial myxedema)
Graves disease
tall, crowded follicular epithelial cells
scalloped colloid
Graves disease
goiter is usually
euthyroid
in iodine deficiency, goiter is initially […], multinodular appearance occurs after […]
diffuse
multiple cycles of hyperplasia and involution
if a patient with multinodular goiter is presenting with obstructive symptoms, what is the best next step?
surgery to relive pressure on airway
**due to extreme fibrosis of nodules, it will not resolve on its own
euthyroid goiter due to cycles of hyperplasa/hypoplasia is most commonly caused by
iodine deficiency
**treat with iodine intake
triple test for thyroid evaluation
hormonal assessment
radiographic imaging
FNA
features that might suggest thyroid neoplasm [5]
solitary nodule
younger age
male
prior radiation
non-functional (cold)
which type of nodule is closely associated with malignancy?
cold (non-functional)
carcinomas arising from thyrocytes [2]
follicular
papillary
medullary carcinoma comes from […] cells
C cells
only definitive treatment for thyroid cancer
surgical removal
benign tumor
solitary, discrete, encapsulated
euthyroid
adenoma
capsular or vascular invasion
RAS or PI3K activation
follicular carcinoma
FNA may be unable to distinguish follicular adenoma from […]
carcinoma
**lobectomy is performed and sent to path. if comes back as carcinoma, do another surgery to remove the entire thing
mutations in what genes increase the risk of papillary carcinoma? [3]
RET
BRAF
NTRK1
empty-appearing nuclei with central clearing
psamoma bodies
nuclear grooves
papillary carcinoma
derived from C cells
medullary carcinoma
associated with MEN2A and 2B mutations
medullary carcinoma
calcitonin producing tumor
medullary carcinoma
sheets of polygonal cells in an amyloid stroma
medullary carcinoma
increased TSH
decreased T4
primary hypothyroidism
decreased TSH
increased T4
primary hyperthyroidism
most appropriate first test for evaluation of thyroid function
TSH
lymphocytes, plasma cells, Hurthle cells
Hashimoto
papillary clusters of cells with optically clear nuclei (orphan Annie eyes)
papillary carcinoma
spindle cells and colloid
medullary carcinoma
abundant colloid
scant follicular cells
simple goiter
best next step in evaluation of nodule found on US?
FNA
hyperthyroidism
exophthalmos
skin changes
Graves
antibodies directed toward TSH receptors are associated with
Graves
serum calcitonin may be elevated in
medullary carcinoma
anti-thyroglobulin antibodies are found in
Hashimoto
causes of smooth/diffuse goiter [4]
Graves
Hashimoto
iodine deficiency
TSH-secreting pituitary adenoma
causes of nodular goiter [4]
thyroid adenoma
thyroid cancer
toxic multinodular goiter
thyroid cyst
**FA says iodine deficiency is smooth, Mathur says its multinodular so do with that information what you will
***Nodular if long lasting
familial medullary thyroid carcinoma are caused by inherited […] mutations
RET
