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Endo/Repro: Week 1 > Krafts: Thyroid Pathology > Flashcards

Krafts: Thyroid Pathology Flashcards

1
Q

Where does the thyroid come from?

A

The tissue that forms the back of the tongue!

Pharyngeal epithelium>
travels down the thyroglossal duct (can form thyroglossal cyst at midline)

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2
Q

What malformations are associated w/ the thyroid?

A

thymus in thyroid

parathyroids in thyroid

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3
Q

What are the three levels of thyroid control?

A
  1. TRH>
  2. TSH>
  3. Thyroid growth/ thyroid synthesis
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4
Q

What are the 4 actions of T4?

A

Brain development
Bone growth
Beta-adrenergic effects
BMR increase

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5
Q

What are the two lab tests down most frequently to evaluate the thyroid

A

T4= hyper vs hypothyroidism (little change of T4 can elicit a big change in TSH)

TSH= problem in thyroid or pituitary

*inversely related

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6
Q

High T4 w/ low TSH

A

Primary hyperthyroidism–problem is in the thyroid

Low TSH–pituitary is responding appropriately to high T4

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7
Q

High T4 and high TSH

A

Problem isn’t the pituitary>
too much TSH>
driving hyperthyroidism

SEcondary or tertiary hyperthyroidism

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8
Q

Low T4 and High TSH

A

Primary HYPOthyroidism

problem in thyroid

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9
Q

Low T4 and Low TSH

A

secondary or tertiary hypothyroidism

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10
Q

What lab results are seen with subclinical hyper/hypo thyroidism?

A

T4 is normal but since TSH is more sensitive there is a response

hyper- LOW TSH
hypo-HIGH TSH (pit responding to sluggish thyroid gland even though T4 hasn’t dropped)

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11
Q

When would you order free T3?

A

If a pt presents w/ hypo/hyperthyroidism but T4 is normal

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12
Q

What Ab tests would you do if you think the pt has an autoimmune issue related to the thyroid?

A

anti-peroxidase Ab
anti-thyroglobulin Ab
anti-TSH receptor Ab

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13
Q

What is hyperthyroidism?

A

A hypermetabolic state caused by increased thyroid hormones.

1°: thyroid problem
2°: pituitary problem
3°: hypothalamic problem

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14
Q

What are signs of hyperthyroidism?

A

General: weight loss, heat intolerance

Cardiac: rapid pulse, arrhythmias

Neuromuscular: tremor, emotional lability, jittery

Skin: warm, moist

Gastrointestinal: diarrhea

Eye: lid lag

Thyroid storm: extreme, dangerous symptoms (in a pt who’s not well controlled)

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15
Q

What is lid lag?

A

Sign of hyperthyroidism

Eye lid is so stimulated it lags behind the eye as a pt looks down

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16
Q

What are common causes of hyperthyroidism?

A

Graves disease
Multinodular goiter
Thyroid adenoma

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17
Q

What are uncommon causes of hyperthyroidism?

A

Thyroiditis
Drugs
Thyroid carcinoma
Pituitary adenoma
Struma ovarii (tumor of the ovary composed of thyroid tissue)
Factitious- taking drug to elevate thyroid level

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18
Q

What is hypothyroidism?

A 
A hypometabolic state caused 
by decreased thyroid hormones.
1°: thyroid problem
2°: pituitary problem
3°: hypothalamic problem
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19
Q

What are sxs of hypothyroidism?

A

General: fatigue, weight gain, COLD intolerance

Cardiac: slow pulse, impaired contraction

Nervous: DELAYED reflexes, lethargy

Skin: rough, dry; hair loss (eyebrows)

Gastrointestinal: reduced appetite, constipation

Myxedema: deepened voice, “edema”

Myxedema coma: deteriorating mental status

*tired, sluggish, depressed

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20
Q

What is myxedema?

A

swollen tissue full of myxoid substances

sign of hypothyroidism

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21
Q

What is congenital hypothyroidism?

A

children w/ hypothyroidism

tends to be more severe

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22
Q

What causes congenital hypothyroidism? How do you tx it?

A

Causes: iodine deficiency, genetic problems

Symptoms are mild to severe

Treatment: thyroid hormone replacement

Prevention better

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23
Q

What are common causes of acquired (arise in adulthood) hypothyroidism?

A

Hashimoto*

Iatrogenic

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24
Q

What are uncommon causes of hypothyroidism?

A 
Goiter
Infiltrative stuff
Too much iodine
2° hypothyroidism
3° hypothyroidism
Other thyroiditis
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25
Q

What is thyroidITIS?

A

inflammation of the thyroid gland

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26
Q

Who does thyroiditis predominantly affect?

A

F> M

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27
Q

What happens if you give a pt w/ thyroiditis radioactive iodine?

A

Decreased uptake–thyroid isn’t very active

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28
Q

What is the MC cause of hypothyroidism in the US? ?

A

Hashimoto Thyroiditis

COMMON in F»M
Autoimmune disease

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29
Q

How does Hashimotos present?

Mrs. Potato Head

A

painless big thyroid>
eventual hypothyroidism

myxedema

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30
Q

What labs do you do to evaluate/dx Hashimoto Thyroiditis?

A

Usual primary hypothyroidism findings (Low T4, increased TSH)

Anti-thyroid Abs: ANTI-PEROXIDASE Abs

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31
Q

How does Hashimoto thyroiditis appear microscopically?

A

WHOPPING lymphoid infiltrate

Hurthle Cells= Big and pink cytoplasmic cells

32
Q

What happens to T cells in Hashimotos?

A

T cells are SCREWED UP and don’t recognize the thyroid as SELF. So they ATTACK they thyroid gland and stimulate B cells to make Abs to sit on the thyroid epithelial cells so NK cells will eat them.

33
Q

How do the B cells unwittingly help the T cells in Hashimotos?

A

produce ANTI PEROXIDASE Ab

34
Q

Autoimmune destruction of the Thyroid?

A

Hashimoto

35
Q

What is DeQUervain Thyroiditis (REX)?

A

Recent URI>
Big sore thyroid (acute onset)>
early on leads to hyperthyroidism (inflammation disrupts follicles)>
Self-limiting

*looks scary but is harmless

36
Q

What is seen histologically with De quervain?

A

Lymphoid infiltrate
Degenerating follicles>
Foreign Body Giant cells> granulomas

(URI> immune response> cross rxn w/ the thyroid> IS attacks thyroid gland> colloid leaks out of follicles into parenchyma> FBGs= mphages that coallesce)

37
Q

What is the mechanism of De quervain?

A

Viral infection initiates.
Antigen causes an increase in CD8 cells.
Damaged follicles leak colloid.
Foreign-body giant cell reaction ensues.

38
Q

What is silent thyroiditis?

HORSE

A

Post-partum/middle age (two peaks)>
painless, slightly enlarged thyroid>
mild hyperthyroidism early on

Often clinically silent

39
Q

What is seen histologically for silent thyroiditis?

A

Lymphoid infiltrate

ABSENCE of Hurthle cells, big germinal centers

40
Q

What is the pathogenesis of silent thyroiditis?

A

Autoimmune?

Inherited?

41
Q

What is Reidel (Fibrosing) Thyroiditis?

WOODY

A

RARE

Rock hard-WOODY- neck mass (formed by fibrosis)>
hypothyroidism>
Tracheal compression

42
Q

How does reidel thyroiditis appear under the microscope? Pathogenesis?

A

Lots of fibrosis

NOT known

43
Q

Hyperthyroidism, opthalmopathy (bulging eyes) and dermopathy (rare) are the characteristic clinical triad for…

A

Grave’s Disease

COMMON
F»M (autoimmune)

44
Q

What labs are done to evaluate Grave’s Disease?

A

Usual primary hyperthyroidism (High T4, low TSH)

Radioactive iodine scan: diffuse increased uptake (ACTIVE THYROID)

45
Q

What are the histological charachteristics of Graves Disease?

A

“busy” thyroid

Papillae and scalloped colloid

46
Q

What is the pathogenesis of Graves Disease?

A

Anti-TSH-receptor Abs that are STIMULATORY leads to:

  1. Follicular cell proliferation> thyroid gets BIG
  2. Thyroid hormone release> sxs of hyperthyroidism
47
Q

TSH receptors in other tissues leads to what known sxs of Graves Disease?

A

Abs bind in OTHER tissues too:

  1. Behind the eyes (retro-orbital tissues)> gets attacked> inflammation> bulging eyes
  2. Fibroblasts in the skin (pre-tibial)> dermopathy
48
Q

How do you tx Graves Disease?

A

Decrease symptoms

  1. β blocker
  2. Surgery if necessary

Decrease thyroid hormone synthesis

  1. Drugs
  2. One-time 131-I ablation
  3. Surgery
49
Q

What is a goiter?

A

BIG thyroid gland

50
Q

What can cause a goiter?

A

Inflammatory (thyroiditis) or non-inflammatory (DEFECTIVE T4 synthesis)

51
Q

What underlies most goiter cases?

A

Decrease in T4 production>
increase TSH from pit>
BIG thyroid

52
Q

What are the causes of decreased T4?

A

No iodine
Enzyme defects
Unkown

53
Q

What is a simple goiter? What causes a multinodular goiter?

A

Simple goiter (bigger than normal thyroid)>
hyperplasia–involution>
more susceptible to trauma>
multinodular goiter (contains nodules separated by fibrous bands and is bumpy)

54
Q

What are histological indications of a goiter?

A 
Hyperplasia
Involution (stops trying to make more follicular epithelium and goes back to a resting state)
55
Q

How do you tx a goiter?

A

Try levothyroxine, or do a thyroidectomy.

Beware giving iodine to a pt w/ an iodine def goiter–thyroid has so much capability to make TH that it can be deadly

56
Q

How do most thyroid neoplasms present?

A

As nodules

Most are BENIGN (adenoma not carcinoma)

57
Q

What can help you determine the likelihood of thyroid cancer?

A

Patient is male
Nodule is solitary and cold
There is a history of radiation

58
Q

How do you dx thyroid cancer?

A

thyroid fine needle aspiration

biopsy if that is not conclusive

59
Q

After a biopsy or FNA that shows cancer or just follicular cells, what do you do?

A

Take out the thyroid

60
Q

What’s more common–thyroid adenoma or carcinomas?

A

adenomas (not cancer!)

61
Q

What are the clinical findings associated with a thyroid adenoma?

A

Common!
Most patients are euthyroid
Some hyperthyroid

62
Q

What lab tests are used to dx thyroid adenoma?

A

TSH and T4 NORMAL

adenoma is COLD

63
Q

Describe the morphology of a thyroid adenoma.

A

solitary
encapsulated (BENIGN)
NO invasion

64
Q

What genetic mutation may cause a thyroid adenoma?

A

G protein mutation

GOF mutation> makes cells grow

65
Q

How do you tx a thyroid adenoma?

A

TAKE it OUT
even if its benign

*need to see a whole capsule to tell the two apart

66
Q

What is the MC thyroid malignancy?

A

Papillary thyroid carcinoma

67
Q

Who does a papillary thyroid carcinoma usually affect?

A

F>M

30-50

68
Q

What is the prognosis for papillary thyroid carcinoma?

A

LOCAL LN metastasis (visceral metastasis rare)>

EXCELLENT prognosis

69
Q

What are characteristic histologically findings associated with a papillary thyroid carcinoma?

A
  1. Orphan Annie nuclei (CLEAR nuclei)
  2. Psammoma (SANDY) body (in ANY papillary carcinoma)
  3. Pseudoinclusion (place where cytoplasm has invaginated)
  4. Nuclear grooves
70
Q

Why is papillary carcinoma known as the little orphan annie tumor?

A 
Affects YOUNGER women
Stays around for years w/out getting bigger
Well behaved, doesn't kill lppl
Nuclei resemble OA eyes
Psammoma bodies (dog SANDY)
71
Q

Who does follicular thyroid carcinoma predominantly affect? How does age affect prognosis? If mets are present where are they?

A

F>M
40-50s

Prognosis worsens w/ pt AGE, tumor size and invasiveness

LUNG or BONE

72
Q

What histological findings are associated with follicular thyroid carcinoma?

A

VASCULAR invasion

73
Q

What is medullary thyroid carcinoma?

A

UNCOMMON malignancy of C cells that sit between follicles and make calcitonin (endocrine tumor)

most are sporadic but some are familial

F>M, 50-60

*most pts present w/ distant mets

74
Q

What are characteristics of medullary thyroid carcinoma?

A

Amyloid from calcitonin that tumor produces (weird proteins stuck together)

Salt and Pepper nucleus (commonly seen w/ an endocrine nucleus)

75
Q

What is a rare, bulky, fast growing, invasive neck mass that is usually metastatic at diagnosis?

A

Anaplastic thyroid carcinoma

F>M, 50-60

VERY BAD

Anaplastic (BAD/UGLY- cells are so undifferentiated that you can’t tell what they are or what cell they came from)

76
Q

What histological findings are associated with Anaplastic thyroid carcinoma?

A

Ugly cells
hyperchromatism
can’t tell what anything is

Endo/Repro: Week 1 (10 decks)

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