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SBCP Pathology > Endo: Thyroid Disease > Flashcards

Endo: Thyroid Disease Flashcards

1
Q

True/false: Thyroid develops embryologically from laryngeal epithelium

A

False, develops from pharyngeal epithelium and descends in neck

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2
Q

Why does ectopic thyroid tissue occur?

A

Thyroid descends down neck as it develops

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3
Q

Weight of thyroid

A

15-20g

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4
Q

Thyroid receives nerve supply from ____ _____ nerves

A

cervical sympathetic

Influences thyroid secretion by acting on blood vessels

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5
Q

Thyroid follicles are surrounded by___ epithelium

The centre of the follicle contains ____ which stores the thyroid hormone

A

Thyroid follicular epithelium

Colloid

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6
Q
  1. ___ released by pituitary after action of THRH from hypothalamus
  2. TSH acts on thyroid to release __ and lesser amounts of ___
A
  1. TSH

2. T4, lesser amounts of T3

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7
Q

T3 and T4 are reversibly and loosely bound in circulation to ________

A

Thyroxine binding globulin TBG

Maintains level of free T3 and T4 within narrow limits

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8
Q

What is a multinodular goitre?

A

NON NEOPLASTIC, common disorder, presents later in life

Progressive cycle of hyperplasia followed by degeneration and fibrosis. Gland becomes enlarged and nodular

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9
Q

Multinodular goitre: A degenerate process of ______ and regression.

A

Hyperplasia

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10
Q

Histology: Cystic change within follicles so they are dilated and filled with colloid. Surrounded by fibrosis. Gland shows architectural nodularity and is overall enlarged

A

Multinodular goitre

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11
Q

Most common causes of hyperthyroidism? (3)

A

Diffuse toxic hyperplasia (Graves) (85%)

Toxic multinodular goitre

Toxic adenoma

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12
Q

Uncommon causes of hyperthyroidism

A

Thyroiditis

Exogenous thyroxine or TSH

Secreting pituitary adenoma

Neonatal thyrotoxicosis

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13
Q

Cardiac and MSK clinical features of hyperthyroidism

A

Overactivity of SNS

Tachycardia
Palps.
Arrhythmia
Congestive HF

Atrophy of MSK tissues
OSTEOPOROSIS

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14
Q

Neuromuscular clinical features of hyperthyroidism

A

Tremor
Hyperactivity
Anxiety
Irritability

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15
Q

Skin and GI clinical features of hyperthyroidism

A

Warm skin
Sweating

Increased appetite
Weight loss
Increased bowel mobility

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16
Q

How is hyperthryoidism diagnosed?

A

Free levels of T4 in peripheral blood

TSH level will be suppressed

Radioactive iodine uptake will be increased

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17
Q

Causes of hypothyroidism

A

Radiation/surgery
HASHIMOTO THYROIDITIS

Idiopathic primary hypothyroidism (blockade of TSH receptors)

Iodine deficiency
Drugs (lithium, iodides)

Pituitary or hypothalamus lesions lowering TSH or TRH

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18
Q

Hypothyroidism in infancy:

___ in iodine deficient areas.

Poor development of ____ and ___ along with mental retardation

A

Endemic

Skeleton, CNS

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19
Q

Another name for hypothyroidism

A

Myxoedema

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20
Q

Clinical features of adult hypothyroidism (myxoedema)

A 
Decreased sweating
Constipation
Weight gain
Feeling cold
Accumulation of matrix substances in subcut. tissue

Slowing of physical/mental activity
Depression

LOW CARDIAC OUTPUT-SOB, decreased exercise tolerance

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21
Q

Diagnosis of hypothyroidism

A

Difficult clinically

Decreased T3, T4

Raised TSH

**NB pituitary or hypothalamic causes may have low TSH

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22
Q

Reidel’s thyroiditis

A

Progressive fibrous replacement of the thyroid tissue

Causes hypothyroidism

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23
Q

Palpation thyroiditis

A

Histological changes due to pre-operative handling or palpation of tissue

Hypothyroidism

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24
Q

Gross changes seen in Hashimotos thyroiditis

A

Symmetrical atrophy of thyroid tissue

Hypothyroidism

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25
Q

Hashimotos thyroiditis: Histology features are ____ tissue and epithelial ___ cell change (oncocytic cells)

A

Lymphoid

Pink

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26
Q

Histology:
The thyroid epithelial cells also show a characteristic change. They have abundant eosinophilic, or pink cytoplasm, and this is known as oncocytic, or Hurthle cell metaplasia.

A

Hashimoto’s thyroiditis

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27
Q

What is most common cause of thryoiditis?

A

Hashimoto’s thyroiditis

28
Q

Pathology of Hashimoto’s thyroiditis

A

Autoimmune disease due to defect in T cells (cellular and humoural immunity)

Activation of thyroid specific CD4 cells and CD8 cytotoxic cells

B cells secrete anti TSH factors

HYPOTHYROIDISM

29
Q

High prevalence of HLA DR3 and DR5 in which thyroid disease?

A

Hashimoto’s thyroiditis

30
Q

Who gets Hashimoto’s thyroiditis?

A

F:M is 15:1

Typically 45-65

31
Q

Presentation of Hashimoto’s thyroiditis?

A

Painless thyroid enlargement

32
Q

What diseases are linked to Hashimoto’s thyroiditis?

A

Increased incidence of B cell lymphoma of thyroid

Associated with other auto-immune diseases

33
Q

What are the specific manifestations of Grave’s disease?

A

Infiltrative opthalmopathy: Immune mediated infiltration of periocular muscles and soft tissue

Pretibial myxoedema

34
Q

Age range affected by Grave’s disease?

A

20-40 years

Mostly females

35
Q

HLA B8 and DR3 linked to which thyroid disease

A

Grave’s

36
Q

Pathology of Grave’s disease

A

TSH receptor autoantibodies mimic TSH and stimulate thyroid hormone production

37
Q

Lab findings in Grave’s disease

A

Raised free T3 and T4, TSH decreased

38
Q

Histology: Diffuse tightly packed hyperplastic follicles with pseudopapillae. Involves both lobes. No nuclear features

A

Grave’s

39
Q

What percentage of cancers are made up of malignant thyroid cancers?

A

1%

40
Q

Populations most affected by thyroid cancer

A

Younger adults

Females more than men

41
Q

Features suggestive of thyroid cancer (3)

A

Solitary nodule
Enlarged nodes
Nodule in YOUNGER PT

42
Q

Thyroid adenoma: Discrete solitary mass derived from ____ epithelium

A

Follicular

43
Q

Thyroid adenoma: Shares architectural features with follicular cancer except has an intact surrounding ____-

A

capsule

44
Q

Which type of thyroid mass has these histological subtypes? Microfollicular
Macrofollicular
Oncocytic (Hurthle cell)

A

Thryoid adenoma

45
Q

True/false: There is no vascular invasion associated with a follicular adenoma

A

True

46
Q

Risk factors for thyroid malignancy

A

NB: Most cases are sporadic

Ionising radiation

Genetic factors (eg Cowden syndrome, FAP, familial PTC syndrome)

MEN syndrome- medullary carcinoma

47
Q

Which thyroid cancer is linked to MEN syndrome?

A

Medullary carcinoma

Multiple endocrine neoplasia syndrome

48
Q

4 subtypes of thyroid carcinoma?

A

Papillary (80%)
Follicular (10%)
Medullary(5%)
Anaplastic(<5%)

49
Q

Most common subtype of thyroid cancer?

A

Papillary carcinoma

50
Q

Age range affected by papillary carcinoma

A

20-40 years

51
Q

Papillary carcinoma metastases %?

A

10-15%

52
Q

10 year survival rate of papillary carcinoma

A

98%

53
Q

Mechanism of follicular carcinoma metastasis?

A

Blood-borne route

54
Q

Mechanism of papillary carcinoma metastasis?

A

Via lymph nodes

55
Q

Difference between follicular carcinoma and adenoma?

A

Carcinoma breaches the capsule and/OR invades the BVs

56
Q

Medullary carcinoma: _____ carcinoma derived from parafollicular __ Cells- sheets, nests or trabeculae of small dark cells

A

Neuroendocrine

C Cells

57
Q

Which hormone is secreted by medullary tumours that can aid diagnosis?

A

Calcitonin

58
Q

Stromal change associated with medullary carcinoma?

A

Pink amyloid deposition

59
Q

What percentage of medullary carcinomas are inherited?

A

Up to 25%

Associated with MEN 2A and 2B

and familial MTC (medullary thyroid carc.) syndrome

60
Q

5 year survival rate of medullary carcinoma

A

80% but may metastasis early

61
Q

Which main thyroid cancer subtype is undifferentiated?

A

Anaplastic carcinoma (pleomorphic or spindled tumour cells)

62
Q

Mortality of anaplastic carcinoma?

A

90-100%!!!

63
Q

How does anaplastic carcinoma spread?

A

Rapid extensive local infiltration of the neck

64
Q

What is a poorly differentiated carcinoma?

A

Tumour which is intermediate morphologically between a differentiated thyroid tumour and an undifferentiated one (anaplastic)

True follicles or well formed papillae are not the main feature of these tumours

65
Q

5 year survival of poorly differentiated carcinoma

A

50%

66
Q

Thyroid lymphoma: May complicate _____.

Usually ___ cell and low grade

A

Thyroiditis

B

SBCP Pathology (24 decks)

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