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DERS (endocrine) > L20- Endocrine Pathology II (thyroid) > Flashcards

L20- Endocrine Pathology II (thyroid) Flashcards

1
Q

Thyroid gland:

  • (1) origin
  • (2) functional unit + product
  • (3) other cells + function
  • (4) T3/T4 serum binding proteins
A

1- floor of pharynx

2- follicle => T4/T3 (90%/9%)

3- C cells –> calcitonin

4- TBG, thryoxine-binding prealbumin (transthyretin), albumin

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2
Q

Thyroid follicle structure = (1)

C cell, aka (2), location -(3)

A

1- cuboidal / columnar cells surround colloid (storage form)

2- parafollicular cells
3- between follicles

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3
Q

List the thyroid functions (generally)

A
  • many metabolic functions (catabolic mostly) ==> stimulates basal metabolic rate
  • essential for neurological development (first 1.5 yrs mostly)
  • inc sensitivity of CVS, CNS to catecholamines (SNS)
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4
Q

[Thyroid hormone control]
(1) from hypothalamus stimulates (2) to occur. The result of (2) will activate (3) type receptor in the thyroid gland to stimulate (4).

A

1- TRH
2- pituitary release of TSH
3- Gs receptor (inc cAMP)
4- T3/T4 production

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5
Q

Hyperthyroid Sxs:

  • (1) general
  • (2) GIT
  • (3) CVS
  • (4) unique / others
A

1- (SNS Sxs) weight loss, sweating, heat intolerance, fatigue, anxiety, **proximal neuropathy, lid-lag

2- diarrhea

3- palpitations, *AFib, high-output HF

4- goiter, menstrual disturbances, infertility, osteoporosis

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6
Q

define Thyrotoxicosis

A

endogenous (hyperactive thyroid) or exogenous (thyroid replacement drugs) excess thyroid hormone => classic hyperthyroid Sxs

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7
Q

list most common causes of hyperthyroidism

A
  • **diffuse hyperplasia / Graves disease (most common)
  • toxic adenoma
  • toxic multinodular goiter
  • thyroiditis
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8
Q

Grave’s disease = (1):

  • Igs against (2) to cause (3)
  • (4) are noticeable thyroid changes
  • (5) are key Sxs
A 
1- diffuse hyperplasia
2- HLA associated
3- binds and activates TSH receptors
4- goiter (diffuse enlargement)
5- exophthalmos, pretibial myxedema (non-pitting) [via glycoaminoglycan deposition]
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9
Q

describe Thyroiditis

A

1) Subacute/ De Quervain’s thyroiditis: pain (only disease with pain), tenderness, fever
2) postpartum thyroiditis (natural immunosuppressin in pregnancy)

Stage I- hyperthyroid
Stage II- hypothyroid (destruction)
Stage III- euthyroid

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10
Q

Hypothyroidism Sxs

A
  • lethargy, tiredness
  • cold intolerance
  • dry, brittle hair, dry skin
  • hoarseness
  • weight gain
  • slow relaxation of tendon reflexes, carpal tunnel
  • constipation
  • Xanthelasma
  • psychosis
  • angina, bradycardia
  • generalized myxedema

Hyperprolatinemia (via excess TRH) –> menorrhagia, galactorrhea, infertility

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11
Q

list causes of hypothyroidism (primary, secondary)

A

Primary:

  • Hashimoto’s / Autoimmune
  • Iatrogenic (post-surgery, anti-thyroid drugs, radioactive iodine)
  • congenital
  • iodine deficiency

Secondary:
-pituitary or hypothalamic disorder

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12
Q

Hashimoto’s thyroiditis:

  • associated with Ig(1) against (2) causing (3)
  • (4) Abs are also involved
  • high risk of (5) complication
A

1- IgG
2- HLA associated
3- dec hormone production + destruction of thyroid cells
4- antimicrosomal (antiperoxidase), antithyroglobulin
5- B-cell lymphoma (lymphocyte infiltration)

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13
Q

Hashimoto’s thyroiditis:

  • (1) presentation
  • occasional (2) may be initially present
  • histology shows (3) change allowing for inc risk of (4)
A

1- hypothyroid Sxs, goiter
2- hyperthyroidism (Hashitoxicosis)
3- diffuse lymphocytic / plasma infiltration –> lymphoid follicles (germinal centers)
4- B-cell lymphoma

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14
Q

Congenital hypothyroidism:

  • (1) causes
  • (2) is main Sxs
A

1- anatomic defect, iodine deficiency, Dyshormonogenesis (thyroid hormone enzyme deficiency)

2- Cretinism: protruding tongue, dwarf with short limbs, coarse dry hair, lack of hair / teeth, mental retardation, pot belly (umbilical hernia)

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15
Q

describe Thyroid investigations (the main 2)

A

1) TSH measurement
- follow with T4/T3 levels

2) thyroid Igs
- antimicrosomal / antithyroid peroxidase) + antithyroglobulin (Hashimoto’s)
- TSI (thyroid stimulating immunoglobulins, Graves)

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16
Q

list the other Thyroid investigations

A
  • TRH measurement
  • Thyroid Isotope Scan (malignancies)
  • Fine-needle aspiration (malignancies)
17
Q

Goiter:

  • (1) definition
  • (2) Sxs
  • (3) Types
A

1- visible enlargement of thyroid –> hypo-/hyper-/eu-thyroid

2- dysphagia, hoarseness

3- simple diffuse, simple mutinodular, solitary thyroid nodule

18
Q

Sub-clinical hypothyroidism:

  • (1) Sxs and PE
  • (2) labs
  • risk of (3) development
  • associated with (4)
  • (5) indicates Tx
A 
1- hot flushes, mild goiter
2- elevated TSH, normal T4
3- hypothyroidism (Ig dependent)
4- Atheroma (endothelial dysfunction)
5- TSH >10 (normal is 5)
19
Q

NTI:

  • (1) definition
  • (2) labs
  • (3) causes
A

(non-thyroidal illness)
1- abnormal tests in severe illness

2- normal/low TSH, low T3, normal/low T4

3- TRH suppression, dec T4–>T3 conversion, transport/binding protein abnormality, inflammatory mediator effects

20
Q

tumors of thyroid:

  • mostly (1)
  • (2) list malignant tumors
A

1- adenomas (benign)

2- (CAs are rare) papillary CA, follicular CA, anaplastic carcinoma, medullary carcinoma

21
Q

Adenoma

  • (benign/malignant)
  • derives from (2)
  • (3) mass description
A

1- benign

2- follicular epithelium (follicular adenomas)

4- discrete, solitary mass

22
Q

tumors of thyroid:

  • (1) Dx
  • (2) Tx
  • (3) post-Tx
A

1- tissue biopsy

2- Total Thyroidectomy + replacement T3/T4 (suppress TSH)

3- monitor TSH, thyroglobulin (both should be low)

23
Q

Most thyroid cancers are (1), and (2) is the main characterization.

A

1- papillary CA (85%)

2- Psammoma bodies: papillae + calcifications

24
Q

Papillary carcinoma (thyroid):

  • pathogenesis is related to (1)
  • (2) is the main risk factor
  • spread via (3)
A

1- several gene mutations

2- ionizing radiation

3- LNs

25
Q

Follicular carcinoma (thyroid):

  • (1) is main risk factor
  • (2) makes Dx difficult
  • spreads via (3)
A

(5-15%)
1- dietary iodine deficiency

2- well-differentiated follilces (appears like normal)

3- capsular invasion and blood vessels (rarely LNs)

26
Q

Anaplastic carcinoma of the thyroid:

  • (1) definition
  • (2) incidence rate and mortality rate
A

1- undifferentiated tumors of thyroid follicular epithelium

2- <5% thyroid tumors, ~100% mortality

27
Q

Medullary carcinoma of the thyroid:

  • cancer of (1)
  • (2) causes
  • (3) Tx
A

1- C cells / parafollicular cells

2- sporadic (80%), MEN (multiple endocrine neoplasia syndrome), inherited

3- total thyroidectomy + thyroid replacement + Calcitonin monitoring

DERS (endocrine) (8 decks)

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