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FA - Endocrine > Endo - Pathology (Thyroid) > Flashcards

Endo - Pathology (Thyroid) Flashcards

Pg. 320-323 in First Aid 2014 Sections include: -Hypothyroidism vs. hyperthyroidism -Hypothyroidism -Hyperthyroidism -Thyroid cancer

1
Q

Compare/Contrast hypothyroidism and hyperthyroidism in terms of their 8 major sets of symptoms.

A

(1) HYPO: Cold intolerance (decreased heat production), HYPER: Heat intolerance (increased heat production) (2) HYPO: Weight gain, decreased appetite, HYPER: Weight loss, increased appetite (3) HYPO: Hypoactivity, lethargy, fatigue, weakness, HYPER: Hyperactivity (4) HYPO: Constipation, HYPER: Diarrhea (5) HYPO: Decreased reflexes, HYPER: Increased reflexes (6) HYPO: Myxedema (facial/periorbital), HYPER: Pretibial myxedema (Graves disease), Periorbital edema (7) HYPO: Dry, cool skin; coarse brittle hair, HYPER: Warm, moist skin; fine hair (8) HYPO: Bradycardia, dyspnea on exertion, HYPER: Chest pain, palpitations, arrhythmias, increased number and sensitivity of Beta-adrenergic receptors

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2
Q

What are the following lab findings in hypothyroidism versus hyperthyroidism: (1) TSH (2) free T3 and T4 (3) Cholesterol?

A

(1) HYPO: High TSH (sensitive test for primary hypothyroidism), HYPER: Low TSH (if primary) (2) HYPO: low free T3 and T4, HYPER: High free or total T3 and T4 (3) HYPO: Hypercholesterolemia (due to low LDL receptor expression), HYPER: Hypocholesterolemia (due to high LDL receptor expression)

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3
Q

What is the most common cause of hypothyroidism in idodine-sufficient regions?

A

Hashimoto thyroiditis

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4
Q

What is Hashimoto thyroiditis, and what is its mechanism of damage?

A

An autoimmune disorder (anti-thyroid peroxidase, antithyroglobulin antibodies)

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5
Q

With what HLA type is Hashimoto thyroiditis associated?

A

Associated with HLA-DR5

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6
Q

For what condition does Hashimoto thyroiditis increase the risk?

A

Increased risk of non-Hodgkin lymphoma

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7
Q

When might Hashimoto thyroiditis patients be hyperthyroid, and why?

A

May be hyperthyroid early in course due to thyrotoxicosis during follicular rupture

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8
Q

What are 2 major histologic findings in Hashimoto thyroiditis?

A

Histologic findings: Hurthle cells, lymphoid aggregate with germinal centers

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9
Q

Describe the thyroid upon physical exam in a Hashimoto thyroiditis patient.

A

Findings: moderately enlarged, NONTENDER thyroid

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10
Q

What are 8 conditions/causes of hypothyroidism?

A

(1) Hashimoto thyroiditis (2) Congenital hypothyroidism (Cretinism) (3) Subacute thyroiditis (de Quervain) (4) Riedel thyroiditis (5) Iodine deficiency (6) Goitrogens (7) Wolff-Chaikoff effect (8) Painless thyroiditis

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11
Q

What is another name for Congenital hypothyroidism? What is it, and what causes it?

A

Congenital hypothyroidism (Cretinism); Severe fetal hypothyroidism due to maternal hypothyroidsim, thyroid agenesis, thyroid dysgenesis (most common cause in US), iodine deficiency, dyshormonogenic goiter

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12
Q

What are 6 physical exam/clinical findings of Congenital hypothyroidism (Cretinism)?

A

Findings: (1) Pot-bellied (2) Pale (3) Puffy-faced child with (4) Protruding umbilicus (5) Protuberant tongue and (6) Poor brain development; Think: “the 6 P’s”

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13
Q

In the US, what is the most common cause of Congenital hypothyroidism (Cretinism)?

A

Thyroid dysgenesis (most common cause in US)

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14
Q

What is another name for Subacute thyroiditis? What is it, and what condition does it often folow?

A

Subacute thyroiditis (de Quervain); Self-limited hypothyroidism often following a flu-like illness

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15
Q

What does Subacute thyroiditis (de Quervain) have in common with Hashimoto thyroiditis in terms of its early presentation?

A

May be hyperthyroid early in course

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16
Q

What is significant in the histology of Subacute thyroiditis (de Quervain)?

A

Histology: granulomatous inflammation

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17
Q

What are 4 lab/clinical findings associated with Subacute thyroiditis (de Quervain)?

A

Findings: (1) high ESR (2) Jaw pain (3) Early inflammation (4) very TENDER thyroid; Think: “de querVAIN is associated with PAIN”

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18
Q

What is a major way that Hashimoto thyroiditis and Subacute thyroiditis differ on physical exam?

A

Hashimoto thyroiditis: NONTENDER thyroid; Subacute thyroiditis: very TENDER thyroid

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19
Q

What occurs in Riedel thyroiditis?

A

Thyroid replaced by fibrous tissue (hypothyroid).

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20
Q

To where may the fibrosis in Riedel thyroiditis extend, and what condition does that mimick?

A

Fibrosis may extend to local structures (e.g., airway), mimicking anaplastic carcinoma

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21
Q

Of what disease is Riedel thyroiditis considered to be a manifestation?

A

Considered a manifestation of IgG4-related systemic disease

22
Q

What is the main clinical/physical exam finding in Riedel thyroiditis?

A

Findings: fixed, hard (rock-like, and PAINLESS goiter

23
Q

What are 3 types/causes of hyperthyroidism?

A

(1) Toxic multinodular goiter (2) Graves disease (3) Thyroid storm

24
Q

What defines toxic multinodular goiter, and what causes it?

A

Focal patches of hyperfunctioning follicular cells working independently of TSH due to mutation in TSH receptor

25
Q

What effect does toxic multinodular goiter have on thyroid hormone levels?

A

Increase release of T3 and T4

26
Q

Comment on the malignancy of hot nodules in Toxic multinodular goiter.

A

Hot nodules are rarely malignant

27
Q

What is Jod-Basedow phenomenon? With what thyroid condition is it associated?

A

Jod-Basedow phenomenon - Thyrotoxicosis if a patient with iodine deficiency goiter is made replete; Toxic multinodular goiter

28
Q

What is the most common cause of hyperthyroidism?

A

Graves disease

29
Q

What causes/defines Graves disease, and on what 3 locations does it act? What symptoms relate to each of these locations?

A

Autoantibodies (IgG) stimulate (1) TSH receptors on thyroid (hyperthyroidism, diffuse goiter), (2) Retro-orbital fibroblasts (exophthalmos: proptosis, extraocular muscle swelling), and (3) Dermal fibroblasts (pretibial myxedema)

30
Q

In what context does Graves disease often present? Give an example.

A

Often presents during stress (e.g., childbirth)

31
Q

What causes a thyroid storm, and what is it?

A

Stress-induced catecholamine surge seen as a serious complication of Graves disease and other hyperthyroid disorders

32
Q

What are 6 signs/symptoms in the presentation of thyroid storm? Which is a cause of death?

A

Presents with (1) agitation (2) delirium (3) fever (4) diarrhea (5) coma (6) tachyarrhythmia (cause of death).

33
Q

What is a significant lab finding that may be seen in thyroid storm, and what causes it?

A

May see high ALP due to increased bone turnover

34
Q

How is thyroid storm treated?

A

Treat with the “3 P’s”: beta-blockers (e.g., Propranolol), Propylthiouracil, corticosteroids (e.g., Prednisolone)

35
Q

What may be seen on histology of mulitnodular goiter?

A

Follicles of various sizes distended with colloid and lined by flattened epithelium with areas of fibrosis and hemorrhage

36
Q

Describe the physical exam finding of exophthalmos in a Graves disease patient.

A

Patient with bilateral proptosis and eyelid retraction. Visible sclera causes appearance of a “stare”.

37
Q

What is the treatment option for thyroid cancers? What other thyroid condition can also use this treatment?

A

Thyroidectomy is treatment option for thyroid cancers and hyperthyroidism

38
Q

What are 3 complications of thyroidectomy? Where applicable, explain the cause.

A

Complications of surgery include (1) hoarseness (due to recurrent laryngeal nerve damage), (2) hypocalcemia (due to removal of parathyroid glands), and transection of inferior thyroid artery

39
Q

What are 5 types of thyroid cancer?

A

(1) Papillary carcinoma (2) Follicular carcinoma (3) Medullary carcinoma (4) Undifferentiated/Anaplastic carcinoma (5) Lymphoma

40
Q

What is the most common thyroid cancer? What kind of prognosis does it have?

A

Papillary carcinoma; Most common, excellent prognosis

41
Q

What are 3 histologic findings that characterize papillary carcinoma of the thyroid?

A

(1) Empty-appearing nuclei (“Orphan Annie” eyes) (2) Psammoma bodies (3) Nuclear grooves

42
Q

What are 3 risk factors for papillary carcinoma of the thyroid?

A

Increase risk with RET and BRAF mutations, childhood irradiation

43
Q

What kind of prognosis does Follicular carcinoma of the thyroid have?

A

Good prognosis

44
Q

How is Follicular carcinoma distinguished from Follicular adenoma of the thyroid? Also, in one word, describe the follicles of Follicular carcinoma?

A

Invades thyroid capsule (unlike follicular adenoma), uniform follicles

45
Q

What is the cellular origin of Medullary carcinoma thyroid?

A

From parafollicular “C cells”

46
Q

What is produced by Medullary carcinoma of the thyroid?

A

Produces calcitonin

47
Q

What histologic finding defines Medullary carcinoma of the thyroid?

A

Sheets of cells in an amyloid stroma

48
Q

With what conditions is Medullary carcinoma of the thyroid associated, and what mutation causes these?

A

Associated with MEN 2A and 2B (RET mutations)

49
Q

What patient population is (mostly) affected by undifferentiated/anaplastic carcinoma?

A

Older patients

50
Q

To what extent does Undifferentiated/Anaplastic carcinoma grow? What is its prognosis?

A

Invades local structures, very poor prognosis

51
Q

With what thyroid condition is lymphoma associated?

A

Associated with Hashimoto thyroiditis

FA - Endocrine (15 decks)

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