Chapter 21: Thyroid Gland Basics

Question 1

Neonate discovered several weeks after birth with low T4/T3

Answer 1

Thyroid agenesis - TH initially supplied from mother.

Question 2

Thyroid discovered in an abnormal location.

Answer 2

Ectopic thyroid.

Question 3

Nests of thyroid tissue found along the prior location of the thyroglossal duct.

Answer 3

Heterotopic thyroid tissue.

Question 4

Patient presents with difficulty speaking, swallowing, and breathing. A nodule is found at the base of the tongue.

Answer 4

Lingual thyroid.

Question 5

Thyroid gland is found lateral to the jugular veins and among the cervical lymph nodes.

Answer 5

Lateral aberrant thyroid - may be malignant histologically.

Question 6

Fluid filled cyst in the midline of the neck attached to the hyoid bone.

Answer 6

Thyroglossal duct cyst. Risk for papillary carcinoma.

Question 7

Young patient presents with mental retardation, ataxia/spasticity, deaf/mutism, normal stature, normal T3/T4 levels.

Answer 7

Endemic Cretinism due to 1st trimester iodine deficiency hypothyroidism.

Question 8

Infant presents apathetic, sluggish, pale skin, low temperature, refractory anemia, dilated heart, large abdomen, umbilical hernia. High TSH, low T4/T3

Answer 8

Non-endemic Cretinism, thyroid dysgenesis. If TH not replaced will have stunted growth, mental retardation.

Question 9

Patient presents with a neck mass and dysphagia, inspiratory stridor, facial venous congestion, hoarse voice. Euthyroid without thyroiditis.

Answer 9

Non-toxic goiter = thyroid hyperplasia. Active gland compensation. Can be caused by low iodine intake, lithium, sulfonamides, familial with thyroglobulin gene. Give exogenous TH.

Question 10

Patient presents with fatigue, lethargy, somnolence, inability to focus, myxedema and cold sensitivity.

Answer 10

Adult onset hypothyroidism. Hashimoto’s Defective TH synthesis - congenital mutation in peroxidase enzymes (DUOX/DUOX2) Mutation in NIS (iodine transport) Iodine deficiency Lithium

Question 11

What are some myxedema complications?

Answer 11

Myxedema madness - agitation, depression, paranoid Myxedema heart - Low output, swelling, dilation Myxedema megaolon: Fecal impaction, reduced peristalsis. Boggy face.

Question 12

Inflammation of the thyroid with evidence of a systemic/bloodstream infection.

Answer 12

Acute thyroiditis.

Question 13

Very tender, enlarged thyroid gland with pain. Horase, dysphagia. On histology, thyroid is enlarged with microabscesses and fibrosis. Patchy T-cell/plasma cell/macrophage infiltrate. Granuloma/foreign body giant cells surrounding colloid.

Answer 13

Subacute Thyroiditis “de Quervian Granulomatous” “Giant cell thyroiditis” Caused by virus (Mumps, influenza, adeno, cocksackie, echovirus).

Question 14

Your patient presents with a goiter and hypothyroid symptoms. Histology is done and looks like this. What is the pathology?

Answer 14

Hashimoto’s thyroiditis. Chronic inflammatory infiltrate with atrophic thyroid follicles. Lymphoid follicles with germinal centers.

Question 15

Patient presents with a goiter that is very firm. It looks like this. What is the pathology?

Answer 15

Reidel Thyroiditis - systemic fibrosing disease that affects the thyroid.

Question 16

Patient presents with a goiter and histology is done. What is this?

Answer 16

Graves disease - notice colloid scalloping.

Question 17

Patient presents with elevated serum T4/T3, cardiac arrhythmia or myopathy. No autoantibodies are found. Patient has a history of non-toxic goiter.

Answer 17

Multinodular toxic goiter.

Question 18

Patient presents with goiter and hyperthyroidism. One “hot nodule” is seen by radioactive iodine scan.

Answer 18

Toxic adenoma - solitary hyperfunctioning thyroid adenoma.