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Robbins Pathology- Endocrine (Chapter 24) > Chapter 24- Thyroid > Flashcards

Chapter 24- Thyroid Flashcards

1
Q

Effects of T3/T4 on the liver

A
  • Increased cholesterol synthesis
  • Increased cholesterol reabsorption from plasma
  • Conversion of cholesterol to bile acids
  • increased fat oxidation/synthesis
  • Increased gluconeogenesis
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2
Q

What is the affect of T3/T4 on muscle

A
  • Increased protein catabolism
  • Increased glucose utilization
  • Increased fat oxidation
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3
Q

Where is thyroglobulin synthesized and stored

A

Synthesized and stored in the colloid

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4
Q

What is the most common cause of hyperthyroidism

A

Primary hyperthyroidism

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5
Q

What type of condition does diffuse hyperplasia fall into

A

Aka Graves’ disease

-Hyperthyroidism

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6
Q

What type of condition does hyper functioning multinodular goiter fall into

A

Hyperthyroidism

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7
Q

What type of condition does hyperfunctioning thyroid adenoma fall into

A

Primary hyperthyroidism

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8
Q

What type of condition does pituitary adenoma fall under

A

Secondary hyperthyroidism

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9
Q

IN the cause of suspected hyperthyroidism, which condition is suspected when the TSH level is low

A

Primary hyperthyroidism

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10
Q

IN the cause of suspected hyperthyroidism, which condition is suspected when the TSH level is high

A

Secondary hyperthyroidism, so basically pituitary adenoma

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11
Q

What are the four components of thyroid storm

A
  • Fever
  • Cardiac manifestations
  • GI symptoms
  • Precipitating history (drugs, pregnancy)
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12
Q

During thyroid storm, what are the cardiac manifestations that can be seen

A
  • Tachycardia

- CHF

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13
Q

During thyroid storm, what are the GI symptoms that can be seen

A
  • Diarrhea

- Jaundice

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14
Q

During thyroid storm, what are the past history factors that can contribute

A
  • Pregnancy/postpartum
  • Hemithyroidectomy
  • Drugs, such as amiodarone
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15
Q

What are the treatments for the manifestations seen in thyroid storm

A
  • Beta blockers (for cardiac)

- NSAIDs (for the fever)

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16
Q

What is the Wolf-Chaikoff effect

A

High doses of iodide will decrease the amount of thyroid production

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17
Q

What is the most common cause of hyperthyroidism

A

Graves disease

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18
Q

What are the clinical manifestations of Graves disease

A

1- Hyperthyroidism with gland enlargement
2- Infiltrative ophthalmopathy
3- Pretibial myxedema

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19
Q

What are the histological findings in the case of thyroid gland enlargement

A

Resorption follicles, which are basically just the hyper collection of the thyroid products

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20
Q

What is the cause of ophthalmopathy in Graves

A

1) Lymphocytes invade the preorbital space
2) Fibroblasts have TSH receptor, so are stimulated by TSHR Abs
3) Extraocular muscles swell
4) Hyloranadate and proteoglycans accumulates (aka matrix accumulation)
5) Adipocytes expand and fill space behind eyes

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21
Q

What is pretibial myxedema and what is it indicative for

A

-Infiltrative dermopathy causing scaly indurated skin on the shin area

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22
Q

What are the serum laboratory findings of TSH, T3/T4, TSI in the case of Graves

A
  • T3/T4 high
  • TSH low
  • TSI high (thyroid stimulating Ig)
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23
Q

What are the clinical presentations of congenital hypothyroidism

A

Aka cretinism, from lack of thyroid:

  • Mental retardation
  • Growth retardation
  • Course facial features
  • Umbilical hernias
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24
Q

What are the genetic components that can cause congenital hypothyroidism

A
  • PAX8, FOXE1, TSH receptor mutations all cause defects in thyroid development
  • THRB mutations cause thyroid hormone resistance syndrome
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25
Q

What are the clinical skin findings in the case of hypothyroidism

A

Skin is:

  • Course (follicular keratosis)
  • Cool
  • Dry
  • yellowish (carotenemia)
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26
Q

What is the most common cause of hypothyroidism

A

Hashimoto thyroiditis

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27
Q

What is the pathogenesis of Hashimoto thyroiditis

A

-Autoantibodies against thyroglobulin and thyroid peroxidase

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28
Q

What is the process of Hashimoto hyroiditis causing hypothyroidism

A

1) Immune mediated insult
2) Hyperactivity and enlargement
3) Follicular cell exhaustion

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29
Q

What are the histological changes seen in Hashimoto thyroiditis

A
  • Lymphcytic infiltrate appearance with germinal centers

- Hurthle cell metaplasia, where there are strophic follicule cells with eosinophilic changes

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30
Q

Which antibodies are present in Hashimoto thyroiditis

A
  • antithyroglobulin AB aka hTg-Ab (80-90%)

- Antiperoxidase antibody aka hTPO-Ab (90-100%)

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31
Q

Which antibody is present in Graves

A

Anti TSH receptor antibody (TSHR-AB or TSI) (80-95%)

32
Q

What is granulomatous thyroiditis

A

Aka DeQuervain’s thyroiditis

-Painful, Granulomatosis condition

33
Q

What is the pathogenesis of Granulomatous thyroiditis

A

-Unknown, maybe viral

34
Q

What are the characteristics of Riddle thyroiditis

A

Fibrosing process that extending from the thyroid into the adjacent tissue

**Feels like cement, or wood, so it is very hard and sticks

35
Q

What are the histological features of Riddle thyroiditis

A

-Fibrosis, with lymphocytes and plasma cells*** (these are secreting IgG4)

36
Q

What is the antibody present in Riddle thyroiditis

37
Q

What are some of the IgG4 conditions

A
  • Riddle thyroiditis
  • Salicary gland
  • Autoimmune pancreatitis***
  • Inflammatory pseudotumors
  • Sclerosing mediastinitis***
  • Idiopathic retroperitoneal fibrosis ***
  • Inflammatory aortic aneurysm
38
Q

What is the cause of a diffuse nontoxic goiter

A

Diffuse aka non-modular

  • Iodine deficiency
  • Goitrogens (cassava root)
  • Brassicaceae (uncooked broccoli, cauliflower, cabbage, radish)
39
Q

How are most diffuse goiter found

A

Mass effect causing:

  • Dysphagia
  • Hoarseness
  • Stridor
  • Superior vena cava syndrome
40
Q

What ages do diffuse goiter tend to occur

41
Q

What age do nodular goiters occur

42
Q

Cold thyroid nodules tend to be which type

A

benign, but higher Neoplastic chance than hot nodules

43
Q

What is the conformation process of a cold nodule

A

Ultrasound and fine needle biopsy

44
Q

What is the process of testing what should be done with a thyroid nodule

A

1) TSH test
2) If low TSH and hot nodule, needs to be removed
3) if low TSH and cold nodule, then needs a fine needle aspiration and ultrasound

45
Q

What are the benign thyroid nodules

A
  • Hyperplastic (adenomatous nodules)

- Follicular adenomas

46
Q

What are the malignant thyroid nodules

A
  • Papillary thyroid carcinoma
  • Follicular cell carcinoma
  • Anaplastic carcinoma
  • Medullary carcinoma
47
Q

What is the prognosis and characteristic of Follicular adenomas

A

Benign tumor that:

  • Clonal population of follicular cells with thyroid autonomy
  • Intact cause or nuclear features
48
Q

What is the prognosis and histological features of papillary thyroid carcinoma

A

Malignant tumor with various features but all have:

  • Orphan Annie Eyes:
  • Papillary architecture
  • Psammoma bodies
49
Q

What determines the prognosis of the papillary thyroid carcinoma

A

The age, with < 55 being more promising than older

50
Q

What are the histological features of follicle variant of papillary thyroid carcinoma

A

-Follicular architecture but the nuclear features of papillary carcinoma

51
Q

Follicular variant of papillary carcinoma tends to have which mutation

52
Q

What is the prognosis of a tall cell variant of papillary carcinoma

A

-Seen in older patients and is very aggressive

53
Q

The diffuse sclerosing variant of papillary carcinoma is commonly seen in which population

A

Children and young adults

54
Q

The diffuse sclerosing variant of papillary carcinoma show which characteristics

A
  • Greater incidences of distant metastasis

- Shorter periods of disease free survival

55
Q

What are the locations that the diffuse sclerosing variation of papillary carcinoma metastasize to

A

Lung **
Brain
Bone
Liver

56
Q

Which form of papillary carcinoma has the most favorable outcome

A

Diffuse sclerosing form (mostly because they occur in younger ages)

57
Q

What are the characteristics of follicular carcinoma

A

Invasive properties

58
Q

Where are follicular carcinomas normally seen

A

Areas where there are goiters from iodide deficiency

59
Q

What are the histological findings of follicular carcinoma

A
  • Invasion of the capsule gives a mushroom appearance

- Invasion of the blood vessels leading to hematogenous metastasis

60
Q

What is the significance of the invasion characteristic of follicular carcinoma

A

Spreads to the vasculature, so there is much more hematogenous metastasis

61
Q

What are the the histological patterns seen in anaplastic thyroid carcinoma

A

Shows areas of papillary carcinoma with well defined border mixed with areas of a high grade tumors

62
Q

What is the prognosis of anaplastic carcinoma

A
  • Seen in older patients and is Highly aggressive

- Presents with mass effect and die within a year

63
Q

What are the gene mutations seen in papillary carcinomas

A

Gain of Functions:

  • RET/PTC (tyrosine kinase activity)
  • BRAF (map kinase signaling)
64
Q

What is the gene mutation in Follicular carcinomas

A

-PAX8-PPARG

65
Q

What are the gene mutations in anaplastic carcinoma

66
Q

What is the function of the C cells in the thyroid

A

-Release calcitonin

67
Q

What are the histological cells found in a normal thyroid

A
  • C cells

- Follicular cells

68
Q

Medullary carcinomas of the thyroid are composed of which cells

69
Q

What are the histological findings in medullary carcinoma

A
  • Neuroendocrine carcinoma from C cells
  • Blue cells that show dispersed chromatin
  • Amyloid
  • C cell hyperplasia
70
Q

What is the staining that can be used to see medullary carcinomas

A

-Congo red stain, as there is amyloid deposition in the thyroid in this carcinoma

71
Q

What form of medullary carcinomas are most common

A

Sporadic forms

72
Q

What are the characteristics of sporadic medullary carcinomas

A
  • Unification tumors
  • Seen in age of 50
  • Agressive
73
Q

What determines the grade a medullary carcinoma and the survival rate

A

-The rate of metastasis and LN involvment

74
Q

What form of medullary carcinoma shows the most favorable outcome

A

Familial (100% 15 year survival)

75
Q

What is the gene mutation seen in medullary carcinomas

76
Q

What are the three most common causes of hyperthyroidism

A
  • Graves leading to diffuse hyperplasia
  • hyper-functional multinodular goiter
  • Hyperfunctional thyroid adenoma

Robbins Pathology- Endocrine (Chapter 24) (5 decks)

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