Chapter 15 Flashcards
what is a multi nodular goiter?
MULTINODULAR GOITER
A. Enlarged thyroid gland with multiple nodules (Fig. 15.2)
B. Due to relative iodine deficiency
C. Usually nontoxic (euthyroid)
D. Rarely, regions become TSH-independent leading to T4 release and hyperthyroidism
(‘toxic goiter’).
what are the clinical features of hashitmotos?
Clinical features
l. Initially may present as hyperthyroidism (due to follicle damage)
2. Progresses to hypothyroidism; decreased T4 and increased TSH
3. Antithyroglobulin and antimicrosomal antibodies are often present (sign of
thyroid damage).
what is on histology of hashimotos?
Chronic inflammation with germinal centers and Hurthle cells (eosinophilic metaplasia of cells that line follicles) is seen on histology
Increased risk for B-cell (marginal zone) lymphoma; presents as an enlarging thyroid gland late in disease course
what is on histology of de quervains?
SUBACUTE GRANULOMATOUS (DE QUERVAIN) THYROIDITIS
A. Granulomatous thyroiditis that follows a viral infection
B. Presents as a tender thyroid with transient hyperthyroidism
is de quervains hypo or hyperthyroid?
Self-limited; does not progress to hypothyroidism
what is reidels thyroiditis? what is seen on physical exam?
III. REIDEL FIBROSING THYROIDITIS
A. Chronic inflammation with extensive fibrosis of the thyroid gland
B. Presents as hypothyroidism with a ‘hard as wood,’ nontender thyroid gland
C. Fibrosis may extend to involve local structures (e.g., airway).
1. Clinically mimics anaplastic carcinoma, but patients are younger (40s), and malignant cells are absent
what is special about the way follicular carcinoma likes to spread?
follicular carcinoma likes to spread hematogenously
which is against normal principles!!
alk phos and cAMP levels in primary hyperparathyroidism?
both increased
Pseudohypoparathyroidism
Pseudohypoparathyroidism is due to end-organ resistance to PTH.
Labs reveal hypocalcemia with increased PTH levels.
Associated with short 4th and 5th digits
Somatostatinomas present as…
Somatostatinomas present as achlorhydria (due to inhibition of gastrin) and cholelithiasis with steatorrhea (due to inhibition of cholecystokinin).
VIPomas present as…
VIPomas secrete excessive vasoactive intestinal peptide leading to watery diarrhea, hypokalemia, and achlorhydria.
why is cushings associated with HTN?
cortisol up regulates alpha 1 receptors on the arterioles which then increases the use of norepinephrine
what is the most important etiology of addison disease to remember?
Chronic insufficiency (Addison disease) is due to progressive destruction of the adrenal glands.
- Common causes include autoimmune destruction (most common cause in the West), TB (most common cause in the developing world), and….
**metastatic carcinoma (e.g., arising from lung)*
- Clinical features include hypotension, hyponatremia, hypovolemia,
hyperkalemia, weakness, hyperpigmentation (increased ACTH by-products stimulate melanocytic production of pigment), vomiting, and diarrhea.
what syndromes is pheo associated with?
Associated with MEN 2A and 2B, von Hippel-Lindau disease, and neurofibromatosis type 1
MEN 1
Pituitary adenoma
parathyroid hyperplasia
pancreatic tumors
