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SYSTEMIC PATHOLOGY > Endocrine > Flashcards

Endocrine Flashcards

1
Q

hormones produced by thyroid + fn

A
  • T3/ T4 produced by follicular cells
    Regulate BASAL METABOLIC RATE (BMR)
    for growth + maturation
  • calcitonin produced by parafollicular cells
    inhibit bone resorption - decrease serum Ca levels
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2
Q

hyperthyroidism

- signs and symptoms

A
  • weight loss
  • heat intolerance
  • Oligomenorrhea (infrequent menses)
  • diarrhoea
  • irritable/anxious state
  • increased appetite
  • staring gaze, lid lag, lid retraction, chemosis (conjuctiva of eye gets red), exophthalmos (bulging of eyes)
  • warm and sweaty
  • tachycardia, AF
  • myopathy/ myxoedema
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3
Q

hyporthyroidism

- signs and symptoms

A
  • weight gain
  • cold intolerance
  • menorrhagia (decrease menses)
  • constipation
  • mental slowness
  • poor appetite
  • dry and cool
  • bradycardia, pericardial effusion
  • myopathy
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4
Q

autoimmune hyperthyroidism

+ biochemical test levels

A

grave’s disease
- primary hyperthyroidism
high T3/T4, low TSH

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5
Q

autoimmune hyporthyroidism

+ biochemical test levels

A

hashimoto thyroiditis
- primary hypothyroidism
low T3/T4, high TSH

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6
Q

functional abnormalities causing hyperthyroidism (3)

A
  • Graves disease (85%)
  • Multinodular goitre
  • Adenoma
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7
Q

functional abnormalities causing hyporthyroidism (2)

A
  • Hashimoto thyroiditis (60%)

- Iatrogenic (stress)

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8
Q

groups of diseases of thyroid (4)

A
  • Congenital anomalies
  • Hyperplasia (diffuse and nodular goitre)
  • Thyroiditis and Immune disorders
    Hashimoto thyroiditis
    DeQuervain thyroiditis
    Graves disease
  • Neoplasms: Adenoma
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9
Q

diseases related to diffused goitre**

A

Graves’ disease
Hashimoto Thyroiditis
DeQuervain thyroiditis
Simple hyperplasia

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10
Q

diseases related to localised swelling of thyroid gland**

A

Nodular goitre
Neoplasms
Hashimoto Thyroiditis
DeQuervain thyroiditis

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11
Q

congenital anomalies of the thyorid (4)

A
  • Thyroglossal duct cyst
  • Abnormal development
  • ectopic thyroid tissue (thyroid tissue appearing elsewhere)
  • Thyroid dyshormonogenesis (goitre caused by thyroid hormone synthesis defects)
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12
Q

diseases leading to abnormal development of thyroid gland (5)

A 
Thyroid aplasia/agenesis
Total absence of thyroid gland 
Serum thyroglobulin is undetectable
Hypoplasia
Incomplete development of orthotopic (correctly located) thyroid
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13
Q

diseases leading to thyroglossal duct cyst

A

Embryonal vestige
Midline neck cyst - midline lesion**
Infection
malignant change

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14
Q

ectopic thyroid tissue growth

- possible locations

A
  • upper GIT
  • upper resp tract
  • soft tissues of neck
  • CVS
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15
Q

Thyroid dyshormonogenesis pathogenesis

A

inherited defects in synthesis of thyroid hormones

  • > reduce free T3/T4
  • > activates TSH secretion
  • > overstimulation and hyperplasia of defective thyroid gland
  • > congenital hypothyroidism
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16
Q

hyperplasia of thyroid gland

  • clinical presentation
  • cause + pathogenesis
A
  • enlargement of gland (goitre)
  • due to abnormal iodine availability/ impaired synthesis of thyroid hormones
    -> compensatory increase in TSH through
    hypertrophy and hyperplasia of follicular cells
    -> enlargement of thyroid gland
    -> recurrent hyperplasia and involution
    ->nodular enlargement (MNG)
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17
Q

2 types of goitres

A
  • simple goitre

- multinodular goitre

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18
Q

simple goitre morphology

- 2 stages + histo appearance

A
  1. hyperplastic stage
    Diffuse mild enlargement
    Crowded columnar cells, pseudopapillae
  2. Colloid involution
    Flattened cuboidal epithelium
    Abundant colloid
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19
Q

multinodular goitre

  • complications
  • indications for surgical removal
A

compression on trachea, recurrent laryngeal nerve (hoarseness), difficulty swallowing
leading to hyperthyroidism

indications for removal: 4Cs
- compression
- cosmesis
- clinical symptoms
- cancer (malignant change)
\+ not responding to treatment
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20
Q

autoimmune conditions

A
  • Grave’s disease

- Hashimoto thyroiditis

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21
Q

thyroiditides (3)

A

swelling/ inflammation of the thyroid gland leading to over/under production of thyroid hormones

  • Hashimotos
  • Subacute (granulomatous) thyroiditis / DeQuervain thyroiditis - granuloma in the thyroid gland
  • Riedel thyroiditis
22
Q

Hashimoto thyroiditis

  • who does it commonly affect
  • pathogenesis
A
  • women (45-65yrs)
  • family history (HLA-DR3/5 genotypes)

Immune mediated cytotoxic destruction of thyrocytes
activation of CD4+ Th cells to thyroid antigens
-> Cytotoxic CD8+ T cell mediated cell death
-> Activation of B-cells
-> autoantibodies against thyroglobulin, TSH receptor and thyroid peroxidase (antiTPO & anti-TSH & anti-Tg**) at thyroid gland
-> decrease T3/T4

aetiology: autoimmune -> clinically hyperthyroid -> hypothyroid

23
Q

Hashimoto thyroiditis

  • gross features
  • histo features
A
  • white/pale - cause of the lymphocytes
  • infiltrates: reactive lymphoid follicles, lymphocytes, plasma cells
  • Thyroid follicles – atrophic, Hurthle (oncocytic) cell change
  • Fibrosis
24
Q

Hashimoto thyroiditis

- complications

A
  • other autoimmune diseases**: Type 1 DM, SLE, Sjogren syn, rheumatoid arthritis
  • progress into B cell lymphoma (MALT lymphoma)**
25
Q

Grave’s disease

  • who does it commonly affect
  • pathogenesis
A
  • women (20-40yrs)
  • family history (HLA-B8/DR3 genotypes)**

pathogenesis:

  • Thyroid stimulating immunoglobulin (TSI): mimics actions of TSH -> stimulates release of thyroid hormones
  • Thyroid growth stimulating immunoglobulins (TGI)
  • TSH-binding inhibitor immunoglobulins (TBH)
  • Anti-TPO, Anti-thyroglobulin autoantibodies
26
Q

Grave’s disease

  • gross features
  • clinical presentation**
A
  • reddish cause of the thyroid follicles

clinical TRIAD
1. Hyperthyroidism
2. Infiltrative ophthalmopathy
- Increased volume of retro-orbital tissue
- infiltration by mononuclear inflammatory cells, oedema, accumulation of extracellular matrix (glycosaminoglycans)
3. Infiltrative dermopathy
shiny round or oval lesion of thin skin over the front lower parts of the lower legs that does not hurt

27
Q

Grave’s disease

- gross (2) and histo (3) appearance

A
  • Symmetrical diffused enlargement
  • Soft, reddish meaty cut surface
  • Follicular cells tall, columnar, crowded = pseudopapillae
  • Colloid: Pale, scalloped
  • Lymphoid infiltrates, reactive lymphoid follicles
28
Q

Subacute (granulomatous) thyroiditis/ DeQuervain thyroiditis

  • who it commonly affects
  • pathogenesis
A
  • women (30-50yrs)

- viral infection / post-viral inflammatory process -> T lymphocyte-mediated damage to follicular cells

29
Q

Subacute (granulomatous) thyroiditis/ DeQuervain thyroiditis

  • symptoms
  • gross/histo features
  • treatment
A
  • pain in the neck, goitre
  • Enlarged, firm gland
  • Patchy – firm, pale yellowish areas with intervening normal parenchyma
  • Destruction of follicles, neutrophils/ microabscesses
    GRANULOMA:
  • Lymphocytes, plasma cells, histiocytes around damaged follicles
  • Multinucleated giant cells, engulfing pools of colloid
  • self-limiting, dont need treatment
30
Q

Riedel thyroiditis

  • pathogenesis
  • histo features
  • clinical presentation
A
  • autoimmune disease
  • Extensive fibrosis of thyroid and surrounding structures
  • chronic inflammatory infiltrates
  • hard, FIXED mass -> mimics thyroid carcinoma
31
Q

benign thyroid tumours (2)

A 
- adenoma
Follicular adenoma (more common)
Hurthle cell adenoma (orange-brown colour)
32
Q

thyroid adenoma **

  • clinical features (2)
  • gross features (3)
  • micro features
A
  • painless nodule
  • COLD nodule = does not produce thyroid hormones
  • Rounded, encapsulated well demarcated** nodule
  • Intact capsule (NO invasion into thyroid parenchyma)
  • Bulging from the cut surface
  • intact capsule w/ no invasion
  • no vascular invasion also
  • (follicular) uniformed follicles, distinct from parenchyma - good sign
  • (Hurthle cell) signs of oncocytic change
33
Q

malignant thyroid tumours (6)**

A

(MAP LIF(E))

  • Follicular carcinoma
  • Papillary carcinoma
  • Hurthle cell carcinoma
  • Poorly differentiated (insular) carcinoma
  • Anaplastic carcinoma
  • medullary thyroid carcinoma (affect parafollicular cells)
34
Q

Follicular carcinoma

  • characteristic
  • 2 subtypes
A
  • capsular/ vascular invasion
    (capsular invasion will have better prognosis than vascular invasion)
    grossly, FC may look like follicular adenoma - LOOKS encapsulated
  • minimally invasive (MIFC)
  • widely invasive - not common
    metastasis through bloodstream**
    affect lungs/bone/liver
35
Q

Follicular carcinoma

  • affects who more
  • determinants of prognosis
A
  • women
  • prognosis depends on degree of invasion
    MIFC > widely invasive
36
Q

Hurthle cell carcinoma features

A

Similar to FC except the cells are oncocytic

37
Q

Papillary carcinoma

  • affects who more
  • prognosis**
  • metastasis**
A
  • 20-40yrs
  • good prognosis (95%)**
  • metastasises through lymph nodes**
    NOT bloodstream
38
Q

Papillary carcinoma

  • clinical presentation
  • gross and micro features**
A
  • Painless nodule (cold)
  • Enlarged cervical lymph nodes
  • compression of related structures: hoarseness, cough, dysphagia

Gross:

  • Solitary / multifocal
  • may be encapsulated or also infiltrative
  • Whitish nodules, cystic change, calclfications, fibrosis

micro:
based on nuclear features
- Finely dispersed chromatin (ground glass/ Orphan Annie eye nuclei)
- Nuclear grooves
- Pseudoinclusions - indicates malignancy

39
Q

classical papillary thyroid carcinoma histo features** (5)

A
  • well formed papillae with fibrovascular cores
  • uniform, cuboidal cells, diagnostic nuclear features
  • Psammoma bodies (purple cabbage looking like thing)
  • Fibrosis, calcifications
  • Lymphatic invasion
40
Q

NIFTP tumour
(non-invasive follicular thyroid neoplasm with papillary-like nuclear features)
- malignancy
- histo features

A

BENIGN!!

  • Encapsulated with NO capsular invasion
  • Follicular pattern
  • Nuclear features of PTC
41
Q

Poorly differentiated (insular) carcinoma

  • histo features
  • metastasis
A
  • large islands of cells
  • usually invasive
  • spread via lymphatics and vascular
42
Q

Anaplastic carcinoma

  • who it affects more
  • prognosis**
  • clinical presentation
A

~65yrs
- extremely poor prognosis** (months)
anaplastic = poor cell differentiation

  • Rapidly enlarging, bulky mass
  • Compressive symptoms: dyspnoea, dysphagia, hoarseness
    Often spread beyond thyroid -> Mets to lungs
43
Q

Anaplastic carcinoma

- histo appearance

A

highly pleomorphic

  • Giant tumour cells
  • Spindle cells (sarcomatoid features)
  • presence of small anaplastic cells 
44
Q

medullary carcinoma

  • affects what cells
  • prognosis
A
  • affects parafollicular cells: produce calcitonin
  • can be caused by MEN syndrome** -> must look for other related tumours so can treat early!!

prognosis:
worse if its sporadic (not inherited)

45
Q

medullary carcinoma

  • clinical presentation
  • micro features
A
  • Mass
  • Paraneoplastic syndrome
  • Raised serum calcitonin
Cells:
- epithelioid or spindled
- salt and pepper chromatin 
Architecture:
- Nests, trabeculae, follicles

Amyloid (Congo Red stain positive)
C cell hyperplasia – MEN, familial MTC

46
Q

thyroid lymphoma

  • diagnosis
  • type of lymphoma
A
  • arises in background of Hashimoto thyroiditis
  • causes sudden enlargement in elderly patient -> do biopsy!!
  • B cell non-Hodgkin lymphoma
47
Q

investigations for thyroid lesions

A
  • ultrasound: superficial to skin - good choice
  • X-ray and CT scan not suitable for soft tissue
  • Fine needle aspiration cytology
    Value: Simple procedure, can detect some conditions
  • Cytology
    If neoplastic: cell type ( squamous cell, adeno, lymphoid), may be able to determine benign/malignant based on cellular features
    If inflammatory, determine if infectious or inflammatory disorder
    Limitations: high false negative rate as the sample taken may not be representative.
    + Unable to ascertain capsular invasion in the case of thyroid malignancy (follicular adenoma/ carcinoma)
48
Q

papillary carcinoma variants (5)

A
  • classical PTC
  • follicular variant
  • encapsulated
  • papillary microcarcinoma
  • tall cell variant
49
Q

investigative test for Addison’s disease

A

Addison’s disease = adrenal insufficiency

- synacthen test

50
Q

what does dexamethasone test test for

A

cushing’s syndrome = too much serum cortisol

SYSTEMIC PATHOLOGY (27 decks)

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