DIT XVI: Endocrine Flashcards
Name given to thyroid hormone-secreting teratoma
Struma ovarii
S&S of hypothyroidism
wt gain, cold intolerance, constipation, lowering of voice, menorrhagia, slowed mental & physical fxn, dyr skin with coarse brittle hair, reflexes showing slow return ohase, facial/periorbital myxedema
Myxedema of hyper vs hypothyroidism
Hyperthyroidism: pretibial myxedema
Hypothyroidism: facial/periorbital myxedema
Rx for hypothyroidism
Levothyroxine (synthetic T4 analogue), triiodothyronine (T3)
Causes of cretinism
Iodine-deficient diet (in mom or baby). thyroid-related enzyme def, thyroid develop’tl defect, failure of thyroid descent, transfer of anti-thyroid Abs during gestation
Clinical findings in congenital hypothyroidism
Cretinism = “6 P’s”: Pot-bellied, Pale, Puffy-faced, Protruding umbilicus, Protuberant tongue, Poor brain develop’t
Painless vs painful goitre
Painless: Hashimoto’s thyroiditis, Riedel’s thyroiditis
Painful: Subacute (de Quervain) thyroiditis
Dx test for Hashimoto’s thyroiditis
antithyroglubulin, antithyroid peroxidase Abs
Genes assoc with Hashimoto’s thyroiditis
HLA-DR5, HLA-B5
What cancer is associated with Hashimoto’s thyroiditis
B-cell lymphoma
What diseases are associated with Hashimoto’s thyroiditis?
DM, pernicious anemia, Sjogrens
Most common type of thyroid cancer
Papillary carcinoma
Second most common type of thyroid cancer
Follicular carcinoma
Thyroid cancer assoc with activation of receptor tyrosine kinases
Papillary and medullary carcinomas
Cancer arising from parafollicular C cells
Medullary carcinoma
Thyroid cancer commonly assoc with either RAS mutation or PAX8-PPAR gamma I rearrangement
follicular carcinoma
Thyroid cancer commonly assoc with rearrangments in RET oncogene or NTRKI
papillary carcinoma
Thyroid cancer associated with mutation in BRAF gene (serine/threonine kinase)
papillary carcinoma
MOA of propylthiouracil (PTU)
Inhibits peroxidase and 5’-deiodinase: blocks addition of iodide onto tyrosine groups of thyroglobulin, decreases periph conversion of T4 –> T3
ADRs of propylthiouracil and methimazole
rash, agranulocytosis, aplastic anemia
MOA of methimazole
Inhibits peroxidase: blocks addition of iodide onto tyrosine groups of thyroglobulin
Risk factor for subacute (de Quervain) thyroiditis
recent viral infection: cocksackievirus, measles, mumps, etc
Findings in subacute (de Quervain) thyroiditis
painful goitre, fever, focal destruction with granulomatous inflammation, raised ESR
Findings in Riedel’s thyroiditis
Macrophages, eosinophils, painless goitre, fibrous tissue that can extend into airway (can mimic anaplastic carcinoma)
“Orphan Annie eye”
empty appearing nucleus, associated with papillary carcinoma of thyroid
Histological findings in papillary carcinoma of thyroid
“Orphan Annie eye”, psammoma bodies, nuclear grooves
Risk factors for papillary carcinoma of thyroid
RET & BRAF mutations, childhood irradiation, NTRK1
Follicular carcinoma vs follicular adenoma of thyroid
Carcinoma: invades thyroid capsule
Adenoma: doesn’t go through fibrous capsule
Mode of spread of follicular carcinoma of thyroid
Hematogenous spread
Risk factors for follicular carcinoma of thyroid
RAS mutation, PAX8-PPAR gamma 1 mutation
Findings in medullary carcinoma of thyroid
increased calcitonin, sheets of cells in amyloid stroma
Risk factors for medullary carcinoma
MEN2A & 2B (RET mutations)
Complications of thyroidectomy
Damage to parathyroid glands (decr Ca2+) and recurrent laryngeal nerve (hoarseness)
Enlarged thyroid cells with ground glass appearance
“Orphan Annie” eye nuclei (papillary carcinoma)
