Endocrine

Question 1

hashimotos thyroiditis epiD

Answer 1

• Number 1 cause of hypothyroidism (where dietary iodine is sufficient)
• 10-20 times more common in women than men
• Most common between ages of 45 & 65 (older compared to grave’s)

Question 2

morphology of hashimotos thyroiditis

Answer 2

• Gross
  
  • Pale, enlarged thyroid gland (most commonly diffuse, may be localised)
  • Pale yellow firm cut surface with or without nodules
• Histology
  
  • Infiltrate comprising lymphocytes & plasma cells
  • Thyroid follicles - atrophic, Hurtle/Oncocytic cell change

Question 3

clinical features of hashimotos

Answer 3

• Painless goitre (often diffuse, may be localised)
• Hypothyroidism (low T3 and T4, high TSH)
• Presence of anti-TPO, anti-TSH, anti-Tg antibodies

Question 4

complications of hashimotos

Answer 4

• Higher risk of B cell lymphoma of thyroid
  
  • e.g. MALT lymphoma

Question 5

graves disease epiD

Answer 5

• Number 1 cause of endogenous hyperthyroidism
• Women 7 times more likely than men
• Most common between the ages 20 & 40

Question 6

graves morphology

Answer 6

• Gross
  
  • Symmetrical, diffuse enlargement
  • Soft, reddish meaty cut surface (looks like rare steak)
• Histology
  
  • Follicular cells are tall & overcrowded, giving rise to pseudopapillae
  • Pale, scalloped colloid
  • Lymphocytic infiltration, reactive lymphoid follicles

Question 7

graves clinical features

Answer 7

• Clinical triad specific to Graves’ disease
  
  1. Hyperthyroidism
  2. Exophthalmos
  3. Pretibial myxoedema
• Diffuse goitre
• Thyrotoxicosis
• Wide-staring gaze with lid lag

Question 8

lab test results of graves

Answer 8

• Primary Hyperthyroidism (high T3 & T4, low TSH)
• Detection of serum TSI (specific to Graves’ disease)

Question 9

papillary thyroid carcinoma epiD and route of spread

Answer 9

• Most common malignant thyroid tumour
  
  • Young adults (20s-40s), can occur in children
• Associated with exposure to ionising radiation
• Always spreads through lymphatics, hence rarely distant metastasis

Question 10

papillary thyroid carcinoma morphology

Answer 10

• Gross
  
  • Whitish nodules, cystic change, calcifications & fibrosis
• Histology
  
  • Nuclear features (very testable)**
    
    • Finely dispersed chromatin
      
      • ground glass/Orphan Annie Eye nuclei
    • Nuclear grooves
    • Pseudo-nuclear inclusions

Question 11

prognosis of papillary thyroid carcinoma

Answer 11

• Very good prognosis
• 10-year survival rate > 95%

Question 12

follicular thyroid carcinoma mode of spread and key difference from follicular adenoma

Answer 12

Key morphological difference from follicular adenoma is capsular and/or vascular invasion**

- Spreads through bloodstream, might present as distant metastasis

Question 13

difference between type 1 and type 2 DM

Answer 13

• Type 1 DM
  
  • rapid B-cell destruction leading to absolute insulin deficiency
• Type 2 DM
  
  • due to impaired b-cell function and increasing insulin resistance

Question 14

diagnosis of diabetes

Answer 14

• Random plasma glucose: > 11.1 mmol
• Fasting plasma glucose > 7 mmol/L
  
  • Pre-diabetic: 6.1 -6.9 mmol/L
• Glycated Hb (HbA1c) > 7%

Question 15

complications of diabetes

Answer 15

• Microvascular disease
  
  • Retinopathy (blindness)
  • Nephropathy (end stage renal failure)
  • Neuropathy (Lower extremity amputations)
    - Peripheral neuropathy (lower extremities first, more sensory than motor deficits)
• Macrovascular disease
  
  • Ischemic heart disease
  • Ischemic stroke
  • Peripheral vascular disease

Question 16

DeQuervain thyroiditis epiD

Answer 16

• Usually occurs after viral infection
• Women 4 times more likely than men
• Most common between ages 30 & 50