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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
What is thyroidITIS?
inflammation of the thyroid gland
26
Who does thyroiditis predominantly affect?
F> M
27
What happens if you give a pt w/ thyroiditis radioactive iodine?
Decreased uptake--thyroid isn't very active
28
What is the MC cause of hypothyroidism in the US? ?
Hashimoto Thyroiditis COMMON in F>>M Autoimmune disease
29
How does Hashimotos present? Mrs. Potato Head
painless big thyroid> eventual hypothyroidism myxedema
30
What labs do you do to evaluate/dx Hashimoto Thyroiditis?
Usual primary hypothyroidism findings (Low T4, increased TSH) Anti-thyroid Abs: ANTI-PEROXIDASE Abs
31
How does Hashimoto thyroiditis appear microscopically?
WHOPPING lymphoid infiltrate Hurthle Cells= Big and pink cytoplasmic cells
32
What happens to T cells in Hashimotos?
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
How do the B cells unwittingly help the T cells in Hashimotos?
produce ANTI PEROXIDASE Ab
34
Autoimmune destruction of the Thyroid?
Hashimoto
35
What is DeQUervain Thyroiditis (REX)?
Recent URI> Big sore thyroid (acute onset)> early on leads to hyperthyroidism (inflammation disrupts follicles)> Self-limiting *looks scary but is harmless
36
What is seen histologically with De quervain?
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
What is the mechanism of De quervain?
Viral infection initiates. Antigen causes an increase in CD8 cells. Damaged follicles leak colloid. Foreign-body giant cell reaction ensues.
38
What is silent thyroiditis? HORSE
Post-partum/middle age (two peaks)> painless, slightly enlarged thyroid> mild hyperthyroidism early on Often clinically silent
39
What is seen histologically for silent thyroiditis?
Lymphoid infiltrate | ABSENCE of Hurthle cells, big germinal centers
40
What is the pathogenesis of silent thyroiditis?
Autoimmune? | Inherited?
41
What is Reidel (Fibrosing) Thyroiditis? WOODY
RARE Rock hard-WOODY- neck mass (formed by fibrosis)> hypothyroidism> Tracheal compression
42
How does reidel thyroiditis appear under the microscope? Pathogenesis?
Lots of fibrosis NOT known
43
Hyperthyroidism, opthalmopathy (bulging eyes) and dermopathy (rare) are the characteristic clinical triad for...
Grave's Disease COMMON F>>M (autoimmune)
44
What labs are done to evaluate Grave's Disease?
Usual primary hyperthyroidism (High T4, low TSH) Radioactive iodine scan: diffuse increased uptake (ACTIVE THYROID)
45
What are the histological charachteristics of Graves Disease?
"busy" thyroid Papillae and scalloped colloid
46
What is the pathogenesis of Graves Disease?
Anti-TSH-receptor Abs that are STIMULATORY leads to: 1. Follicular cell proliferation> thyroid gets BIG 2. Thyroid hormone release> sxs of hyperthyroidism
47
TSH receptors in other tissues leads to what known sxs of Graves Disease?
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
How do you tx Graves Disease?
Decrease symptoms 1. β blocker 2. Surgery if necessary Decrease thyroid hormone synthesis 1. Drugs 2. One-time 131-I ablation 3. Surgery
49
What is a goiter?
BIG thyroid gland
50
What can cause a goiter?
Inflammatory (thyroiditis) or non-inflammatory (DEFECTIVE T4 synthesis)
51
What underlies most goiter cases?
Decrease in T4 production> increase TSH from pit> BIG thyroid
52
What are the causes of decreased T4?
No iodine Enzyme defects Unkown
53
What is a simple goiter? What causes a multinodular goiter?
Simple goiter (bigger than normal thyroid)> hyperplasia--involution> more susceptible to trauma> multinodular goiter (contains nodules separated by fibrous bands and is bumpy)
54
What are histological indications of a goiter?
``` Hyperplasia Involution (stops trying to make more follicular epithelium and goes back to a resting state) ```
55
How do you tx a goiter?
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
How do most thyroid neoplasms present?
As nodules | Most are BENIGN (adenoma not carcinoma)
57
What can help you determine the likelihood of thyroid cancer?
Patient is male Nodule is solitary and cold There is a history of radiation
58
How do you dx thyroid cancer?
thyroid fine needle aspiration biopsy if that is not conclusive
59
After a biopsy or FNA that shows cancer or just follicular cells, what do you do?
Take out the thyroid
60
What's more common--thyroid adenoma or carcinomas?
adenomas (not cancer!)
61
What are the clinical findings associated with a thyroid adenoma?
Common! Most patients are euthyroid Some hyperthyroid
62
What lab tests are used to dx thyroid adenoma?
TSH and T4 NORMAL | adenoma is COLD
63
Describe the morphology of a thyroid adenoma.
solitary encapsulated (BENIGN) NO invasion
64
What genetic mutation may cause a thyroid adenoma?
G protein mutation | GOF mutation> makes cells grow
65
How do you tx a thyroid adenoma?
TAKE it OUT even if its benign *need to see a whole capsule to tell the two apart
66
What is the MC thyroid malignancy?
Papillary thyroid carcinoma
67
Who does a papillary thyroid carcinoma usually affect?
F>M | 30-50
68
What is the prognosis for papillary thyroid carcinoma?
LOCAL LN metastasis (visceral metastasis rare)> | EXCELLENT prognosis
69
What are characteristic histologically findings associated with a papillary thyroid carcinoma?
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
Why is papillary carcinoma known as the little orphan annie tumor?
``` 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
Who does follicular thyroid carcinoma predominantly affect? How does age affect prognosis? If mets are present where are they?
F>M 40-50s Prognosis worsens w/ pt AGE, tumor size and invasiveness LUNG or BONE
72
What histological findings are associated with follicular thyroid carcinoma?
VASCULAR invasion
73
What is medullary thyroid carcinoma?
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
What are characteristics of medullary thyroid carcinoma?
Amyloid from calcitonin that tumor produces (weird proteins stuck together) Salt and Pepper nucleus (commonly seen w/ an endocrine nucleus)
75
What is a rare, bulky, fast growing, invasive neck mass that is usually metastatic at diagnosis?
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
What histological findings are associated with Anaplastic thyroid carcinoma?
Ugly cells hyperchromatism can't tell what anything is

Endo/Repro: Week 1 (10 decks)

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