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Endocrine > EXAM #1: PATHOLOGY OF THYROID > Flashcards

EXAM #1: PATHOLOGY OF THYROID Flashcards

1
Q

What are the signs and symptoms of hyperthyroidism?

A

1) Hypermetabolism
2) Enhanced epinephrine effect (tremulous and anxiety)
3) Lid lag
4) A-fib
5) Thyroid storm

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2
Q

What is “lid lag?”

A

A delay in the downward movement of the upper eyelid

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3
Q

A young female patient is sweaty with a-fib. What do you need to rule out?

A

Thyroid disease

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4
Q

What is thyroid storm?

A
  • This is an acute, life-threatening, hypermetabolic state
  • Induced by excessive release of thyroid hormones (THs) in individuals with thyrotoxicosis (Grave’s Disease)

Typically from surgery of childbirth

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5
Q

What is Graves’ Disease?

A

Autoimmune disease with production of IgG antibody vs. TSH receptor

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6
Q

What is the sex-predominance in Graves’ Disease?

A

Female

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7
Q

What are the labs that are seen in Graves’ Disease?

A

High T3/T4 with LOW TSH

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8
Q

What are the ophthalmologic consequences of Grave’s Disease?

A

Proptosis/ Exopthalmous

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9
Q

What is myxedema?

A

Swelling of the skin and underlying tissues of the shin giving a waxy/doughy consistency

*This is due to TSH stimulation of fibroblasts with TSHR

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10
Q

What is myxedema most commonly associated with?

A

HYPOthyroid–however, sometimes it is seen in HYPER; be sure to associate with other symptoms

*Iodine deficiency leads to increased TSH release OR, TSH antibodies in graves

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11
Q

What is the gross appearance of the thyroid gland in Grave’s Disease?

A

Diffuse, symmetrically beefy red gland

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12
Q

What is the histologic appearance of Grave’s Disease?

A
  • Pale colloid with resporption vacuoles i.e. “scalloping”

- Hyperplastic follicles with papillary infoldings

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13
Q

What are the signs and symptoms of Hypothyroid?

A

1) Slowing of mind and body

2) Myxedema (accumulation of hydrophilic ground substance in connective tissue)

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14
Q

What is the name of the disease that occurs when a child has hypothyroid?

A

Cretinism

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15
Q

What are the clinical features of cretinism?

A

1) Stunted growth
2) Retarded mental development
3) Delayed bone and tooth development (2-4 months is normal)

Also, facial swelling, puffy eyelids, protruding tongue, low hair line, and altered eyebrows.

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16
Q

When does thyroid hormone need to be replaced to reverse the course of cretinism?

A

Before the 3rd week

*Note that legally you are abound to screen for cretinism

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17
Q

What is Hashimoto Thyroiditis?

A

Chronic progressive thyroid disease

*Presents as hyperthyroid then progresses to hypothyroid

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18
Q

What causes Hashimoto Thyroiditis?

A

Autoimmune destruction of the thyroid gland associated with HLA-DR5

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19
Q

What is the gross appearance of Hashimoto Thyroiditis?

A
  • Diffusely enlarged
  • Pale
  • Intact
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20
Q

What is the histologically pathognomonic for Hashimoto Thyroiditis?

A

Hurtle Cells and chronic inflammation with germinal centers

21
Q

What is a Hurtle Cell?

A

Metaplasia of the cells that line the thyroid follicle due to autoimmune attack

22
Q

What is De Quervain Thyroiditis?

A

Transient granulomatous hyperthyroidism secondary to viral infection

23
Q

What causes De Quervain Thyroiditis?

A

Viral infection esp. by coxsackie and adenovirus

24
Q

What is the sex predominance of De Quervain Thyroiditis?

A

Female

25
Q

What is the unique clinical aspect of De Quervain Thyroiditis?

A

PAIN/TENDERNESS

26
Q

What is a Goiter?

A

Thyroid enlargement, usually due to relative iodine deficiency

27
Q

What causes Goiter?

A

Impaired ability of thyroid to produce thyroid hormone

28
Q

What happens to TSH with goiter?

A

Elevated

29
Q

What causes Goiter?

A

Typically:

  • Decreased iodide
  • Compensatory increase in TSH leads to enlargement
30
Q

What is a Colloid Goiter?

A

Beginning smooth goiter

31
Q

What does colloid goiter progress to?

A

Nodular goiter

32
Q

How will goiter appear histologically?

A

Colloid rich follicles with FLATTENED epithelium

33
Q

What is the difference between hot and cold nodules? Why is it important to known the difference?

A

Hot= palpable mass that accumulates increased radioiodine

Cold= palpable mass that fails to take-up radiolabeled iodine
- More associated with adenoma and carcinoma

34
Q

What is the next step in diagnosing a cold nodule?

A

Fine Needle Aspiration (FNA)

35
Q

What is a thyroid adenoma?

A

Benign thyroid tumor

*Remember–if a female has thyroid adenome and a new problem it is very unlikley the tumor has turned malignant

36
Q

What is the sex predominance of thyroid adenomas?

A

Female

37
Q

What is the most common type of thyroid cancer? What is the prognosis?

A

Papillary= good prognosis

38
Q

What is the type of thyroid cancer with the worst prognosis?

A

Anaplastic

*Nearly all die of it in a short time (3-6 months)

39
Q

What is a major risk factor for papillary thyroid cancer?

A

Ionizing radiation

*Clinically this is associated with children that get radiation to the face for severe acne

40
Q

What is a papillary carcinoma composed of?

A

Papillae lined by cells with

  • Orphan Annie eye nuclei
  • Nuclear Grooves

*Also, papillae are associated with psammoma bodies

41
Q

What is a follicular carcinoma?

A

Malignant proliferation of thyroid follicles surrounded by a fibrous capsule with INVASION through the capsule

42
Q

What is medullary carcinoma?

A

Malignant proliferation of parafollicular C cells

43
Q

What does biopsy of a medullary carcinoma reveal?

A

Sheets of malignant cells in an amyloid stroma

44
Q

What genetic mutation is medullary carcinoma associated with?

A

RET oncogene

45
Q

What disorders is medullary carcinoma associated with?

A

MEN 2A and 2B

46
Q

If a patient has a RET mutation, what surgical procedure is warranted?

A

Prophylactic thyroidectomy

47
Q

What is an anaplastic carcinoma?

A

Undifferentiated malignant tumor of the thyroid

48
Q

What patient population is anaplastic carcinoma typically seen in? What condition is this is stark contrast to?

A

Elderly vs. Riedel Fibrosing Thyroiditis* that is seen in younger patients

*This is chronic inflammation with extensive fibrosis of the thyroid gland–presents as hypothyroid with non-tender, “hard as wood” thyroid

Endocrine (34 decks)

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