Introduction to Thyroid Pathology

Question 1

What is a primary endocrinopathy?

Answer 1

Thyroid disorder

Question 2

What is a secondary endocrinopathy?

Answer 2

Pituitary disorder

Question 3

What is a goiter?

Answer 3

State of enlargement of the thyroid gland

Question 4

What are Goitrogens?

Answer 4

Chemical agents that suppress thyroid function

Question 5

What are C cells?

Answer 5

Parafollicular cells

Question 6

What do parafollicular (C cells) release?

Answer 6

Calcitonin

Question 7

Where are parafollicular cells located?

Answer 7

Within the wall of follicles around follicular cells

Question 8

What is a medullary thyroid carcinoma?

Answer 8

Parafollicular neoplasm

Question 9

What occurs in medullary thyroid carcinoma?

Answer 9

Increased serum calcitonin

Question 10

What is thyrotoxicosis?

Answer 10

Hyperthyroidism

Question 11

What can occur in hyperthyroidism in patients with underlying heart issues?

Answer 11

Low-output hear failure due to dilated cardiomyopathy (left ventricle too dilated so not large ejection fracture)

Question 12

What occurs with lid lag?

Answer 12

Superior tarsal muscle pulls the lid too high so eyes appear to bulge but are not

Question 13

What is true thyroid ophthalmopathy associated with?

Answer 13

Grave’s disease

Question 14

What is cretinism?

Answer 14

Low iodine levels due to insufficient levels in diet; early childhood or mothers diet

Question 15

What diseases can occur due to hypothyroidism?

Answer 15

Cretinism

Myxedema

Question 16

Three differential diagnosis of goiters?

Answer 16

Inflammatory or immune-mediated disease
Non-neoplastic parenchymal enlargement
Neoplasms

Question 17

What is the most useful screening test for hyper and hypothyroidism?

Answer 17

TSH levels

Question 18

TSH levels in hyper:

Answer 18

Low (due to T4/T3 feedback to decrease release)

Question 19

TSH levels in hypo:

Answer 19

High (no T3/T4 to turn it off)

Question 20

What do hot nodules show?

Answer 20

Activity in thyroid

Question 21

What do cold nodules show?

Answer 21

Inactivity due to neoplasms

Question 22

Four thyroid disease categories:

Answer 22

Thyroiditis
Graves disease
Diffuse and Nodular goiter
Neoplasm

Question 23

Four types of thyroiditis:

Answer 23

Hashimoto thyroiditis
Subacute lymphocytic thyroiditis
Granulomatous thyroiditis
Reidel thyroiditis

Question 24

What is Hashimoto thyroiditis?

Answer 24

Hypothyroidism where iodine levels are sufficient

Question 25

What type of goiter does Hashimoto cause?

Answer 25

Painless symmetric and diffuse

Question 26

What causes Hashimoto thyroiditis?

Answer 26

Autoimmune disease with destruction of thyroid gland

Question 27

Why can Hashimoto initially present as hyperthyroidism?

Answer 27

Inflammatory destruction of epithelial cells causing a spillage of T3/T4

Question 28

What cells can be found in Hashimoto thyroiditis?

Answer 28

Hurthle cells

Question 29

What is Subacute lymphocytic thyroiditis?

Answer 29

Autoimmune disease against antithyroid peroxidase

Question 30

What is the goiter in Subacute lymphocytic thyroiditis?

Answer 30

Painless

Question 31

What is a variant of Subacute lymphocytic thyroiditis?

Answer 31

Post-partum thyroiditis

Question 32

What is granulomatous thyroiditis?

Answer 32

Most common cause of thyroid pain; self-limiting; transient inflammation

Question 33

What does granulomatous thyroiditis cause?

Answer 33

Hyperthyroidism from destruction of cells and T3/T4 release

Question 34

What occurs to iodine uptake in granulomatous thyroiditis?

Answer 34

Decreased radioactive iodine uptake

Question 35

What occurs in Reidel thyroiditis?

Answer 35

Extensive fibrosis; maybe associated with pathologic progressive fibrosis

Question 36

How is the thyroid seen in Reidel thyroiditis?

Answer 36

Hard and fixed thyroid that mimics carcinoma

Question 37

What causes Graves disease?

Answer 37

Antibodies against the TSH receptors thus stimulating the receptors

Question 38

What are the underlying cause of Graves disease?

Answer 38

Thyroid stimulating immunoglobulins (TSI)

Question 39

What triad characterizes Graves disease?

Answer 39

Thyrotoxicosis Ophthalmopathy Dermopathy

Question 40

What are the three types of goiters?

Answer 40

Diffuse (simple) Multinodular Dyshormonogenetic

Question 41

What characterizes a diffuse goiter?

Answer 41

Uniform enlargement; TSH elevated but person is euthyroid

Question 42

Two types of diffuse goiters?

Answer 42

Endemic goiter | Sporadic goiter

Question 43

What causes endemic goiters?

Answer 43

Goitrogens or low iodine

Question 44

What causes sporadic goiters?

Answer 44

Young people with unknown cause

Question 45

Diffuse goiter pathology?

Answer 45

None it is non-toxic

Question 46

What characterizes a multinodular goiter?

Answer 46

Numerous discrete nodules

Question 47

Symptoms of multinodular goiters?

Answer 47

Most are euthyroid or can develop autonomous nodules that produce excessive thyroid hormones

Question 48

What is dyshormonogenetic goiter?

Answer 48

Rare but familial goiter

Question 49

What are the general statistics of thyroid neoplasms?

Answer 49

Solitary are more likely to be neoplastic Nodules in younger patients and males are more likely to be neoplastic Hot nodules are more likely to be benign than malignant

Question 50

Four major types of carcinomas:

Answer 50

Papillary carcinoma Follicular carcinoma Anaplastic carcinoma Medullary carcinoma

Question 51

Papillary carcinoma:

Answer 51

85% of cases; Tend to metastasize to cervical nodes

Question 52

Follicular carcinoma:

Answer 52

5-15% of cases; Capsular invasion or vascular invasion by neoplastic cells

Question 53

Anaplastic carcinoma:

Answer 53

5% of cases; Aggressive 100% mortality

Question 54

Medullary carcinoma:

Answer 54

Neuroendocrine carcinoma | C cells secretes calcitonin

Question 55

Two phases of diffuse goiter?

Answer 55

Hyperplastic: Response to demand for more thyroid hormone | Colloid involution: Less demand for thyroid hormone