Endocrine #4 (Thyroiditis and Thyroid Cancer) Flashcards
Hashimoto’s Thyroiditis AKA _________, is the MCC of hypothyroidism in the US.
Explain the pathophysiology of this
-Chronic Lymphocytic Thyroiditis
-Autoimmune thyroid cell destruction by anti-thyroid peroxidase and anti-thyroglobulin antibodies
How do you differentiate Hashimoto’s Thyroiditis from other thyroiditis diseases?
The patients with this condition usually have what symptoms?
It is usually paired with another autoimmune disease (Sjogren’s, MG, Celiac, Addison’s)
Symptoms of hypothyroidism. Enlarged, nontender thyroid/goiter, neck/throat tightness.
What is the treatment for Hashimoto’s Thyroiditis?
Levothyroxine (synthetic T4)
-Synthroid
Subacute Thyroiditis AKA (Granulomatous, Dequervain, Giant Cell) Thyroiditis, is thought to be caused by a _______.
What is it associated with (gene defect)
Antecedant viral respiratory tract infection or post-viral inflammation
HLA-B35
What is the presentation of a patient with subacute thyroiditis (not symptoms, just what do the diagnostics show?)
-Hyperthyroidism followed by euthyroidism, then hypothyroidism, then restoration of normal thyroid function
-It changes as time goes by
Symptoms of subacute thyroiditis
-Painful thyroid gland worse with head movements and swallowing
-Acute pain that radiates to the jaw and ear
-Low grade fever, myalgias, fatigue, malaise
-Diffusely tender goiter!
What do labs show for subacute thyroiditis (think about what should be negative, and what an infection does)
-High ESR + negative thyroid antibodies
-Hyperthyroid early in disease (decreased TSH + increased T4)
On radioactive uptake scan for subacute thyroiditis, what is expected?
Diffuse, decreased iodine uptake (much like Hashimoto’s and Postpartum Thyroiditis)
On biopsy for subacute thyroiditis, what is seen?
Granulomatous inflammation with multinucleated giant cells
Treatment for subacute thyroditis
-Supportive: reassurance because 95% return to euthyroid state
-NSAIDs, Aspirin for pain
-Prednisone if needed for severe pain
Postpartum thyroiditis occurs in 4-7% of women in what time frame after delivery?
Often, this condition is ______
In the first six months after delivery
Painless!
Often postpartum thyroiditis’ cause is due to _________ and what is present on labs that you should remember?
Autoimmune
+ Thyroid antibodies: thyroglobulin antibodies, thyroid peroxidase antibodies (like Hashimoto’s)
Treatment for postpartum thyroidits
-Supportive: Aspirin, NSAIDs
Reidel Thyroiditis, is a rare chronic autoimmune thyroiditis characterized by dense fibrosis that invites the thyroid and adjacent neck structures. What is secreted in this condition?
IgG4-secreting plasma cells
On clinical presentation for Reidel Thyroiditis, what symptoms do you get?
Hypothyroidism Symptoms
-Presents like thyroid malignancy: rock hard, nontender, rapidly growing, fixed goiter
-Compression Symptoms: hoarseness, dysphagia, choking, coughing, increased RR due to airway compression
-NO CERVICAL LAD
What diagnostics are done for Reidel Thyroiditis?
-Increased TSH + decreased T4/T3 (euthyroid or hypothyroid)
-IgG4 serum levels
What diagnostic should you do to distinguish anaplastic thyroid cancer from Reidel Thyroiditis?
Biopsy
What is seen on biopsy for Reidel Thyroiditis?
-Dense fibrosis
Treatment for Reidel Thyroiditis
-Surgical treatment to reduce compression
What is suppurative thyroiditis?
Who does it MC occur in?
-bacterial infection of thyroid gland by Staph Aureus
MC occurs in children, but rare
Symptoms of suppurative thyroiditis
-Thyroid pain and tenderness: sudden neck pain and tenderness. Worse with hyperextension and better with neck flexion
-Overlying erythema of the skin
-Fever, chills, pharyngitis, dysphagia, hoarseness
What diagnostics are done for suppurative thyroiditis?
-Labs: Leukocytosis, increased ESR (due to infection)
-FNA with gram stain and culture
-Thyroid US
Treatment for suppurative thyroiditis
-ABX
-Surgical drainage if fluctuant
The only two causes of a painful thyroid are ______ and _______
Subacute Thyroiditis and Suppurative Thyroiditis
What is an acronym to remember the thyroid cancers in order from MOST common/LEAST aggressive to LEAST common/MOST aggressive?
PFMA
Paul Fucked My Ass
MC type of Thyroid Cancer?
It is MC in what population?
Papillary Carcinoma
Women
Where does metastasis for papillary carcinoma usually occur?
Local (Cerivcal lymph nodes MC)
How do Papillary, Follicular, and Medullary thyroid cancers present?
Painless thyroid nodule
Papillary thyroid cancer has risk factors such as
-After radiation exposure
-Family history of thyroid cancer
-Smoking!
-Females***
-30-60 year old
What diagnostic is usually done for a workup of thyroid cancer?
Thyroid US
FNA
Treatment for papillary thyroid cancer
-Thyroidectomy and then post-op Levothyroxine
Follicular thyroid cancer is a little more aggressive that papillary thyroid cancer. What is one risk factor that is specific to this type that you should remember?
Iodine deficiency
Also, what should you remember about METS with follicular carcinoma?
Follicular goes FAR
-Distant METS more common than local METS (hematogenous spread): lung MC, liver, brain, bone
Treatment for follicular carcinoma
-Thyroidectomy with post-op Levothyroxine
-Radioactive iodine to ablate any remaining tissue
Follicular carcinoma can secrete enough T4 to cause a ______
Thyroid Storm
Medullary Thyroid Cancer, which makes up 3% of all thyroid cancers, is derived from
It should be remembered that 1/3 is associated with what genetic defect?
-Calcitonin-synthesizing parafollicular C cells
MEN IIa or IIb (RET mutation)
For this reason, what do labs show for medullary thyroid cancer?
Increased Calcitonin
Treatment for medullary thyroid cancer
-Total thyroidectomy
-Radioactive iodine to ablate any tissue
The most aggressive type of thyroid cancer is _________
What symptoms does this one have.
-Anaplastic Thyroid Cancer
-Rapid growth, compressive symptoms, dyspnea, dysphagia
What does the thyroid feel like in anaplastic thyroid cancer?
Rock hard thyroid mass, may be fixed
Treatment for anaplastic thyroid cancer
-Most are not amenable to surgical resection
-Radiation or chemotherapy
-Palliative tracheostomy to maintain airway
Anaplastic thyroid cancer is MC in what population?
Elderly (>65)
