Hypothyroidism/Thyroiditis

Question 1

What 2 things can cause Congenital Hypothyroidism?

Answer 1

1. Deficient Iodide Supplementation by the mother

2. Genetic alterations

Question 2

If Congenital Hypothyroidism is due to deficient iodide supplementation, what does it depend on?

Answer 2

Time of onset in the mother

Question 3

What will be seen in the child with Congenital Hypothyroidism?

Answer 3

• Decreased growth and mental function
• Umbilical hernias
• Coarse facial features

Question 4

What will be seen in the child with Congenital Hypothyroidism?

Answer 4

• Decreased growth and mental function
• Coarse facial features
• Umbilical hernias

Question 5

What are 2 cardiac features of Hypothyroidism?

Answer 5

Low output

Hypercholesterolemia

Question 6

List findings with Hypothyroidism

Answer 6

• Mental/physical slowing, weight gain, cold intolerance

- Brittle hair and nails, dry skin, facial edema and coarse voice

Question 7

List findings with Hypothyroidism

Answer 7

• Mental/physical slowing, weight gain, cold intolerance

- Brittle hair and nails, dry skin, facial edema, coarse voice

Question 8

What is Hashimoto Thyroiditis?

Answer 8

Autoimmune Hypothyroidism

Question 9

What autoantibodies will be present with Hashimoto Thyroiditis?

Answer 9

Thryoglobulin

TPO (Thyroid Peroxidase)

Question 10

What autoantibodies will be present with Hashimoto Thyroiditis?

Answer 10

Thyroglobulin

TPO (thyroid peroxidase)

Question 11

In iodide-sufficient areas, what is the most common reason for Hypothyroidism?

Answer 11

Hashimoto Thyroiditis

Question 12

How will the Thyroid be with Hashimoto Thyroiditis?

Answer 12

Diffuse enlargement but PainLESS

Question 13

With Hashimoto Thyroiditis, it normally causes Hypothyroidism. What is an exception of when it can cause Hyperthyroidism?

Answer 13

Hashitoxicosis

Question 14

Describe the pathogenesis cascade with Hashimoto Thyroiditis

Answer 14

• Immune mediated insult
• Hyperactivity and enlargement
• Follicular cell exhaustion

Question 15

What will be seen on histo with Hashimoto Thyroiditis?

Answer 15

• Lymphocytic infiltrate with lymph node germinal centers

- Hurthle cells

Question 16

What will be seen on histo with Hashimoto Thyroiditis?

Answer 16

• Lymphocytic infiltrate with lymph node germinal centers

- Hurthle cells

Question 17

What are Hurthle cells?

Answer 17

Atrophic follicles with eosinophilic change

Question 18

Atrophic follicles with eosinophilic change… what are they? What are they seen with?

Answer 18

Hurthle cells

= Hashimoto Thyroiditis

Question 19

What is confusing and dumb about Hashimoto Thyroiditis and Graves Disease?

Answer 19

Their main presenting antibodies can present with each other and vice versa!
– ex. Hashimoto Thyroiditis presents with (+) TSIs

Question 20

What is another autoimmune thyroiditis besides Hashimoto?

Answer 20

Subacute Lymphocytic Thyroiditis

Question 21

What is Subacute Lymphocytic Thyroiditis?

Answer 21

Transient thyroid hormone irregularities

PainLESS Goiter

Question 22

If there is a goiter present with Subacute Lymphocytic Thyroiditis, will it cause pain? What type of Thyroidism does it present with?

Answer 22

NO pain

– Either hypo/hyperthyroidism

Question 23

What is an example of what can cause Subacute Lymphocytic Thyroiditis? What can it become?

Answer 23

Postpartum Thyroiditis

–> can become permanent Hypothyroidism

Question 24

What likely causes Granulomatous Thyroiditis?

Answer 24

VIRAL infection with granulomatous inflammation

ex. mumps

Question 25

What will be present on histo with Granulomatous Thyroiditis?

Answer 25

Granulomata

Question 26

Will Granulomatous Thyroiditis be painful? What type of Thyroidism does it present with?

Answer 26

YES PAINFUL | -- Either hypo/hyperthyroidism

Question 27

If a patient had a recent viral infection, what thyroiditis are they at risk for?

Answer 27

Granulomatous Thyroiditis

Question 28

Reidel Thyroiditis is what type of disease?

Answer 28

IgG4 related disease

Question 29

What is very severe with Reidel Thyroiditis?

Answer 29

FIBROSIS that extends into adjacent tissues

Question 30

If the Thyroid has very extensive Fibrosis, what should you suspect?

Answer 30

Reidel Thyroiditis -- IgG4 related disease

Question 31

What 3 things will be seen on histo with Reidel Thyroiditis?

Answer 31

1. Fibrosis 2. Lymphocytes 3. PLASMA CELLS (perinuclear hoff)

Question 32

What 3 things will be seen on histo with Reidel Thyroiditis?

Answer 32

1. Fibrosis 2. Lymphocytes 3. Plasma cells

Question 33

How do plasma cells look?

Answer 33

Perinuclear hoff (halo)

Question 34

What is a Goiter?

Answer 34

Thyroid enlargement

Question 35

What type of goiters do younger people vs adults get?

Answer 35

``` Younger = diffuse nontoxic Adults = Multinodular ```

Question 36

With both types of Goiters, what will the symptoms be?

Answer 36

MASS EFFECT | -- Dysphagia, SVC syndrome, stridor, hoarseness

Question 37

With both types of Goiters, what will the symptoms be?

Answer 37

MASS EFFECT | -- Dysphagia, stridor, SVC syndrome, hoarseness

Question 38

Which type of Goiter can become substernal and very large?

Answer 38

Multinodular

Question 39

What are the thyroid levels with a Diffuse nontoxic goiter?

Answer 39

Normal

Question 40

What are a few things that can cause a goiter?

Answer 40

- Iodide deficiency - Sporadic - Cassava root, broccoli, cauliflower, etc.

Question 41

What is the purpose of Radioisotope scanning?

Answer 41

Determines if a thyroid nodule is responsible for hyperfunction

Question 42

What can determine if a thyroid nodule is responsible for the hyperfunction?

Answer 42

Radioisotope scanning

Question 43

Hot nodules and Cold nodules are more often ____

Answer 43

Benign

Question 44

Between Hot and Cold Nodules, which is more likely to be malignant?

Answer 44

Cold

Question 45

Between Hot and Cold Nodules, which is more likely causing the hyperfunction?

Answer 45

Hot

Question 46

Treatment/further workup for Hot and Cold nodules?

Answer 46

Hot - excision or ablation | Cold - US/Fine needle aspiration to determine if malignant