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Path Y > Chemical pathology - Thyroid > Flashcards

Chemical pathology - Thyroid Flashcards

1
Q

What % of T4 is typically bound to TBG?

A

75%

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2
Q

To which proteins can T4 bind?

A

TBG
TBPA
Albumin

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3
Q

Recall 6 possible aetiologies of primary hypothyroidism

A

Hashimoto’s
Atrophic (1st in UK)- no goitre, small thyroid due to lymphocytic infiltration
Lihtium, Amiodarone
Iodine deficiency (1st worldwide)
Riedel’s thyroiditis = dense fibrosis, stony hard
Post thyroidectomy/radioiododine

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4
Q

What is the expected TSH and T4 levels in primary hypothyroidism?

A

TSH high
T4 low

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5
Q

What test should always be done before thyroid-replacement medication is initiated?

A

ECG - because T4 increases cardiac contractility

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6
Q

How does thyroid function change in pregnancy?

A

In 1st trimester, there is a huse rise in hCG
hCG has the same configuration as TSH - this then stimulates the thyroid gland to produce supra-physiological amounts of thyroxine
However, this is normal in pregnancy, so the woman doesn’t become clinically hyperthyroid

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7
Q

What type of non-thyroid malignancy can cause thyrotoxicosis?

A

Malignancy that produces hCG

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8
Q

What test is used to detect neonatal hypothyroidism?

A

Guthrie test on day 2/3 of life

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9
Q

What does the term ‘sick euthyroid’ refer to?

A

Any severe illness –> reduced T4, increased TSH and decreased T3
This is normal physiology in sepsis

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10
Q

Recall 5 differentials for the cause of hyperthyroidism, and how each would appear on a technetium scan

A
  1. Grave’s (40-60% of cases) - high uptake
  2. Toxic multinodular goitre (30-50%) - high uptake
  3. Single toxic adenoma - high uptake
  4. Subacute de quervain’s thyroiditis - low uptake
  5. Postpartum thyroiditis - low uptake
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11
Q

What drugs can be used to treat an overactive thyroid? What is their mechanism of action?

A

Carbimazole and propylthiouracil
Inhibit thyroid peroxidase

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12
Q

What is the main risk of carbimazole and propylthiouracil treatment?

A

Agranulocytosis
- if sore throat or fever, stop testament and seek advice

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13
Q

Over how long should carbimazole and propylthiouracil treatment be titrated ?

A

18 months

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14
Q

How should papillary thyroid Ca be treated?

A

Removal of thyroid gland
Then radioiodine treatment
Then give supraphysiological thyroxine (so Ca cells not reactivated)

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15
Q

Recall 2 tumour markers for medullary thyroid cancer

A

CEA and calcitonin

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16
Q

Which type of thyroid cancer is associated with Men II?

A

Medullary

17
Q

is T3 or T4 active? which is more abundant

A 
T3 = active 
T4 = abundant
18
Q

is the TSH high or low in subclinical hypothyroidism

A

TSH = high but T4 is NORMAL

19
Q

TSH and T4 levels in hyperthyroidism

A

low TSH
high T3 and T4

20
Q

what cell is associated w Hashimoto’s

A

hurthle cell

21
Q

solitary hot nodule on isotope scan =

A

toxic adenoma

22
Q

initially hyperthyroid, then hypothyroid =

A

de quervain’s thyroiditis - self limiting, post viral painful goitre

23
Q

what’s Plummer’s disease

A

toxic multi nodular goitre = painless goitre

24
Q

what psychiatric drug commonly causes hypothyroidism

A

lithium

25
Q

types of thyroid neoplasia (cancer) and prevalence

A

PFMA(L)
papillary (75%) - female, aged 20-40, v good prognosis
follicular (15%) - aged 40 - 60 (increases w age down)
medullary (5%)
anapaestic
lymphoma (maltoma - rf = chronic hashimoto’s)

26
Q

tumour marker of papillary thyroid cancer?

A

thyroglobulin

27
Q

presentation of papillary thyroid cancer?

A

painless cervical lymphadenopathy - spreads to lymph nodes and lung

28
Q

2 histological fin finds of papillary thyroid cancer

A 
psammoma bodies (foci of calcification) 
orphan annie eyes (empty appearing nuclei w central clearing)
29
Q

thyroglobulin is a marker of what thyroid cancers

A

papillary and follicular

30
Q

medullary thyroid cancer is associated with what condition?

A

MEN2

31
Q

medullary thyroid cancer is dervived from what cell? what do they secrete

A

neuroendocrine neoplasm derived from parafolllicular C cells secreting calcitonin

32
Q

2 tumour markers of medullary thyroid cancer?

A

calcitonin
CEA

33
Q

what’s the inheritance of the multiple endocrine neoplasia conditions? outline the types

A

autosomal dominant

MEN 1 = 3Ps = pituitary adenoma, pancreatic tumour and parathyroid hyperplasia

MEN2a = 3Cs = Calcitonin (medullary thyroid cancer), Calcium (parathyroid hyperplasia), Catelcholamines (phaeo)

MEN2b = B for Big (marfanoid) & Belly problems (mucosal neuromas)

Path Y (81 decks)

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