Endo Path - Thyroid / Parathyroid (FA)

Question 1

What are the signs and symptoms of hypothyroidism and hyperthyroidism and the mechanisms responsible for them?

Answer 1

Hypothyroid: Think decrease in BMR and sympathetic NS
- Decr. in BMR from decrease in Na/K ATPase
- Decr. in SNS from decreased response to catecholamines
Hyperthyroid: Opposite is true

Question 2

What is the most sensitive test for primary hypothyroidism?

Answer 2

Decrease in TSH

Question 3

What are the lab findings of T3, T4 and cholesterol levels in hypothyroidism?

Answer 3

Decrease for all - hypocholeterol due to decr. LDL receptors on liver

Question 4

What is the most common cause of hypothyroidism if iodine is sufficient (e.g. in the US)?

Answer 4

Hashimoto

Question 5

What is the mechanism behind Hashimoto?

Answer 5

Autoimmune against thyroid peroxidase and thyroglobulin

Question 6

Histology of Hurtle cells and lymphoid aggregation with germinal centers of the thyroid?

Answer 6

Hashimoto

Question 7

Young woman with nontender, moderately enlarged goiter, and gaining weight?

Answer 7

Hashimoto

Question 8

Look at these histology slides:

http://www.pathologyoutlines.com/topic/thyroidhashimotosthyroiditis.html

Answer 8

Hashimoto

Question 9

Kid born to a mother with hypothyroidism who has a pot belly, is pale, puffy faced, outy umbilicus, thick tongue, and retarded (6 Ps)?

Answer 9

Congenital hypothyroidism (cretinism)

Question 10

Patient with a tender goiter post flu? What its their prognosis?

Answer 10

Subacute thyroiditis (de Quervian)
Self limiting

Question 11

Patient with non tender, hard and fixed goiter with histology of fibrous, well contained tissue? What is the primary concern?

Answer 11

Riedel thyroiditis

Extension into airway

Question 12

What are the 6 primary causes of hypothyroidism?

Answer 12

Hashimoto (most common)
Cretinism
Subacute
Riedel
Iodine deff
Wolff-Chaikoff effect (too much iodine --> peroxidase inhibited)

Question 13

What are the two main hyperthyroid diseases and the primary concern associated with them?

Answer 13

Graves (most common)
Toxic multinodular goiter
Either can lead to thyroid storm

Question 14

What is the most common form of hyperthyroidism and its pathophysiology?

Answer 14

Graves: Autoantibodies (IgG) stimulate TSH receptors on thyroid

Question 15

Young women who presents with tachycardia, delirium, and fever during childbirth? You also notice exophthalmos, pretibial doughy skin, and a slightly enlarged thyroid.

Answer 15

First presentation of Graves

Question 16

Person with weight loss, agitation, lumpy thyroid, increased serum T4, and hot nodules?

Answer 16

Toxic multinodular goiter

Question 17

What is a concern with giving iodine to a person who was previously iodine deficient?

Answer 17

Thyrotoxicosis

Question 18

What is the pathophysiology of a person with toxic multi nodular goiter?

Answer 18

Hyper functioning follicular cells, acting independently of TSH due to mutation in the TSH receptor

Question 19

What is the treatment protocol for a person in a thyroid storm?

Answer 19

Propanolol, PTU, Prednisolone

Question 20

What 5 cancers are associated with the thyroid?

Answer 20

Papillary Carcinoma
Follicular Carcinoma
Medullary Carcinoma
Anaplastic Carcinoma
Lymphoma (Hashimoto)

Question 21

What are the three most common complications of a thyroidectomy?

Answer 21

Hoarseness (recurrent laryngeal nerve damage)
Hypocalcemia (parathyroid glands removed)
Inferior thyroid artery transection

Question 22

What is the most common thyroid cancer?

Answer 22

Papillary Carcinoma

Question 23

Middle age person with a history of irradiation to the neck, empty appearing nuclei, psammoma bodies, and nuclear grooves?

Answer 23

Papillary carcinoma

Question 24

What genetic mutations are associated with papillary carcinoma?

Answer 24

RET and BRAF

Question 25

What is the difference between a follicular adenoma and carcinoma?

Answer 25

Histology will show invasion in carcinoma

Question 26

Person presents with a goiter, hypocalcemia, and elevated calcitonin. Histology show sheets of amyloid deposition in the stroma.

Answer 26

Medullary carcinoma

Question 27

What thyroid disorder is associated with MEN 2A and 2B and what is the genetic mutation?

Answer 27

Medullary carcinoma, RET

Question 28

Older patient with hoarseness and a goiter. Histology reveals local invasion. Dx and prognosis?

Answer 28

Anaplastic carcinoma - very poor

Question 29

What are the types of hyperparathyroidism and their distinctions?

Answer 29

Primary: usually adenoma
Secondary: hyperplasia due to decr Ca++ absorption and
Incr PO4. Usually chronic renal disease
Tertiary: Refractory resulting from chronic renal disease

Question 30

What is the pneumonic used for primary hyperparathyroidism?

Answer 30

Stones, Bones, Groans, and Psych Overtones

Question 31

Patient with cc of constipation, depression and hypercalcemia, incr. PTH, incr. ALP, and incr. cAMP in urine?

Answer 31

Primary hyperparathyroidism

Question 32

What is the pathophys of secondary hyperparathyroidism?

Answer 32

Renal failure –> decreased Vit D –> decr. Ca++ absorption

Question 33

What are the 3 most common causes of hypoparathyroidism?

Answer 33

Surgery, autoimmune, DiGeorge

Question 34

What is pseudohypoparathyroidsims?

Answer 34

Kidney unresponsive to PTH –> decreased Ca++

Question 35

What physical features are common with pseudohypoparathyroidism?

Answer 35

Short 3rd and 4th digits, short stature

Question 36

What are the Chvostek and Trousseau signs and under what condition are they commonly seen?

Answer 36

Chvostek: Tap cheek –> twitch
Trousseau: BP cuff –> carpal spasm
Hypocalcemia

Question 37

Fill in the quadrants of the PTH to Ca level graph…

Answer 37

http://thehormonelab.com/handbook/calcium-disorders/parathyroid-hormone-pth-and-ionized-calcium-ica