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Patho > Endocrine System: Thyroid > Flashcards

Endocrine System: Thyroid Flashcards

1
Q

Thyroid disease what are the 3 associated with activity levels?

A

Euthyroid
Hyperthyroid
Hypothyroid

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2
Q

What is the most common type of Hyperthyroidism disease

A

Grave’s disease

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3
Q

Grave’s disease is most prevalent in which population

A

F, Genetic predisposition, familial tendencies
Most commonly appears in 20-40s

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4
Q

What is Grave’s disease characterized by?

A

hyperthyroid state, goiter, and ophthalmopathy

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5
Q

Graves disease is an autoimmune disorder, explain

A

-Defect in suppressor T lymphocytes which results in an abnormal antibody being produced (TSI)
-Thyroid auto-antibodies found in >95% of cases
-Abnormal lymphocytes secrete TSI (thyroid stimulating immunoglobulins)
-TSI react with TSH receptor or thyroid plasma membrane to mimic TSH >increase secretion of TH

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6
Q

What are the clinical characteristics of Grave’s disease

A

-Thyroid hyperplasia (goiter)
-Hyperthyroidism: increase metabolic state
-Pre-tibial myxedema: subcutaneous indurated erythematous swelling on anterior leg
-Exophthalmus: Caused by infiltration of retro-orbital tissues with lymphocytes, mast cells, & plasma cells. Occurs in 50-70% of cases.

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7
Q

Hyperthyroidism: Toxic Nodular Goiter

A

-Less common and typically less severe than Graves’ disease
-Insidious onset
-More prevalent in elderly (apathetic)
-Can be uninodular or multinodular
-increase # of follicles with goiter possibly secondary to increase need for TH initially
-Later cells function autonomously

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8
Q

Hyperthyroidism: Thyroid Storm, what is it?

A

-extreme and life-threatening form of thyrotoxicosis.
-Seen most often in undiagnosed or inadequately treated
-Precipitated by stressor (often respiratory infection)
-Manifested by very high fever, tachycardia, CHF, angina, delirium, agitation, and restlessness (bc body loses ability to maintain homeostasis)
-High mortality rate
-Seen rarely today due to better diagnostics and treatment

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9
Q

What are the lab findings in primary Hyperthyroidism

A

-increase in T4- free
-increase in T3
-decrease in TSH
-falsely low or normal cholesterol because of the what that thyroid hormone affects metabolism

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10
Q

What is primary hypothyroidism?

A

-Thyroid disease with decrease TH
Adult: myxedema
Juvenile: >1-2 years
Congenital-infants: cretinism

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11
Q

What is secondary hypothyroidism

A

From decrease TSH secondary to pituitary problems (e.g. tumor). Will also see decrease in other pituitary hormones (adenoma)

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12
Q

What is tertiary Hypothyroidism involved with

A

hypothalamus

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13
Q

What is the etiology of primary hypothyroidism

A

Autoimmune thyroiditis
Overly aggressive treatment of hyperthyroidism: Surgical or radioisotope destruction of too much thyroid tissue

Acute thyroiditis: bacterial infection. Rare usually not in pts that have an intact immune system

Subacute thyroiditis: viral or post-partum (more common) alters TGB pts will require more thyroid hormone so after delivery they have a hard time equilibrating agin. can be mistaken for post partum depression

Drug induced: decrease synthesis or release of TH (lithium, amiodarone, steroids)

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14
Q

What are the symptoms of hypothyroidism?

A

Fatigue
Cold intolerance
Hair loss
Weight gain
Constipation
Depression
Impaired memory
Sporadic menses
Decreased libido
Decreased sweating

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15
Q

What are the early/mid signs of Hypothyroidism?

A

Weight gain
Dry coarse skin
Bradycardia
Hypothermia
Hair loss
-Loss lateral 1/3 eyebrow
Dull facial expression- “flat”
Goiter or atrophy (less of these pts have goiter though)

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16
Q

What are the late signs of Hypothyroidism?

A

Periorbital edema
Non-pitting edema of hands & feet (myxedema)
Cardiomegaly & CHF
Decreased Cognition/dementia
Myxedema coma (can be seen in hyper as well)

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17
Q

What are the lab findings in primary Hypothyroidism

A

decrease T4
decrease T3
increase TSH
increase Cholesterol

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18
Q

Primary Autoimmune Thyroiditis

A

-Hashimoto’s Thyroiditis
-5:1 female vs. male
-These cause lymphocytic & plasma cell infiltration & destruction of thyroid tissue
-Goiter, then transient hyperthyroidism, then hypothyroid state

19
Q

What is the most common type of hypothyroidism?

A

Primary Autoimmune Thyroiditis aka Hashimoto’s Thyroiditis

20
Q

What are the Primary Autoimmune Thyroiditis (Hashimoto’s Thyroiditis) Autoimmune antibodies?

A

Antithyroglobulin antibodies (TgAb)
Thyroidal peroxidase antibody (TPO Ab)
TSH Receptor blocking antibody (TSH-R Block Ab)

21
Q

Congenital Hypothyroidism: Cretinism

A

-Common cause of preventable mental retardation (common in most other parts of the world)
-Affects 1:5000 infants worldwide
-Evident in 1st several months
-Can be due to congenital lack of thyroid or abnormal biosynthesis
-TH is essential for normal brain development and growth
-Neonatal screenings have been implemented to detect early
-If treated properly, risk of mental retardation in nonexistent

22
Q

What will the parents who have babies with cretinism report?

A

Constipation
Mental retardation
Feeding problems
Somnolence
Jaundice
Flacidity(”floppy” baby, neurologic issues)

23
Q

What will a child with cretinism appear like?

A

“little old men”
Broad flat nose
Protruding tongue
Protruding abdomen
Development of goiter
Umbilical hernia
Delayed growth, short stature

24
Q

What is Myxedematous Coma?

A

Life-threatening, end-stage hypothyroidism
Coma, hypothermia, cardiovascular collapse, hypoventilation, severe metabolic disorders

25
Q

Which population is Myxedematous Coma seen in?

A

elderly women with chronic hypothyroidism in the winter months (?cold triggered)

26
Q

What is the treatment of Myxedematous Coma?

A

Focus on prevention rather than treatment
Treated supportively and removing precipitation factors if known

27
Q

What is a goiter?

A

Thyroid enlargement, thyroid mass.

28
Q

What is a nontoxic goiter?

A

doesn’t secrete thyroid hormone. TSH, T3, T4 would be fine but there also may be some depression
hypothyroid or euthyroid
-Diffuse
-Colloid: affect the colloid within the follicle
-Colloid nodular: forms clusters of follicles

29
Q

What is the etiology of a nontoxic goiter?

A

Iodine deficiency (endemic)
Biochemical deficit > decrease T4 > elevated TSH > hyperplasia > fibrosis > nodule

30
Q

Thyroid masses: Neoplasms

A

Benign follicular adenoma

31
Q

Thyroid masses: Cancer

A

-Rapid developing nodule
-Previous irradiation (radiation exposure)
-Hard, fixed, adenopathy

32
Q

What are the three types of thyroid cancers?

A
  1. papillary
  2. follicular
  3. medullary
  4. anaplastic
33
Q

Papillary CA

A

Most common (80%). Slow growing. > prevalence in women
if it spreads it will spread to another part of thyroid

34
Q

Follicular CA

A

Slow growing, mets to bone & lung
can spread to other part of thyroid

35
Q

Medulalry CA

A

Genetic or sporadic, C cell (secretes calcitonin)
see metabolic changes with calcium levels

36
Q

Anaplastic

A

the WORST, doesn’t appear to come from any cell type hard to differentiate that its thyroid. its rare but exceedingly malignant.
Rare, Poor prognosis

37
Q

Postpartum thyroiditis

A

can see hyper, hpo, transition from hyper to hypo and most of the time those resolves once thyroid has equilibrated after increase needs from fetal support no longer in play. Can be easily mistaken for post partum depression and anxiety.

38
Q

What are thyroid diseases?

A
  1. Hyperthyroidism/thyrotoxicosis (overactive)
  2. Hypothyroidism/myxedema (underactive)
  3. Enlargement or mass (goiter, nodular)
39
Q

What are the etiologies for primary Hyperthyroidism

A

-increase intake of exogenous TH
*Prescribed too much or in dietary supplement
*Overdose (thyrotoxicosis factitia)
-Graves’ disease
-Toxic nodular goiter

40
Q

What are the etiologies for Secondary Hyperthyroidism?

A

Pituitary secretion (adenoma)

41
Q

What are the etiologies for tertiary Hyperthyroidism?

A

Hypothalamic secretion

42
Q

What are the symptoms of Hyperthyroidism?

A

Weight loss, increased appetite
Nervousness
Palpitations
Oligomenorrhea or amenorrhea

43
Q

What are the signs of Hyperthyroidism?

A

Goiter (97-99% cases)
Weight loss
Tremor
A. fib

44
Q

What is thyrotoxicosis?

A

it is associated with hyperthyroidism and it is too much thyroid hormone in the body

Patho (16 decks)

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