Lecture 16 - Parathyroid and Thyroid Pathology Flashcards
Normal serum PTH ranges from ___-____nM
10-65nM
Granulomatous disease causes Hypercalcemia with decreased PTH bc Macrophages release _______.
Calcitriol (active D3)
Patients with Hyperparathyroidism can present with ____ ____ ____ in long bones (brown tumor - solid tumor - in craniofacial bones), which leaves the bone more susceptible to fracture.
Osteitis Fibrosa Cystica
How many of the Parathyroid glands are typically involved in Parathyroid adenomas?
1
One of the histological Hallmarks of Parathyroid adenoma is the absence of ______.
Fat
How many of the parathyroid glands are typically involved in Parathyroid Hyperplasia? How does this compare to Parathyroid adenoma?
All of them
Parathyroid adenoma typically only involves 1.
15% of parathyroid Hyperplasias are a result of a mutation in _____ but not ______.
MEN 2A
but NOT Men 2B
Parathyroid Carcinoma is diagnosed based on ______ invasion and metastases (typically hard to remove surgically bc they extend beyond parathyroid capsule into surrounding tissues) NOT based on histology.
Vascular
Is it free, bound, or total Thyroid hormone in plasma that exerts negative feedback on AP and Hypothalamus?
Only Free
The most common site of heterotropic thyroid is at the base of the _____.
Tongue
A cystic lesion in the midline of the neck that moves up and down with swallowing can be indicative of a persistent and dilated (or infected) _______ duct. It is typically lined by squamous or ______ epithelium and has a low incidence of associated _____ thyroid cancer.
Thyroglossal duct
Respiratory epithelium
Papillary thyroid cancer
Hypothyroidism in infants can present with ______ (delayed mental development, prominent tongue, and blank face).
Cretinism
Graves’ disease is characterized by a triad of clinical findings:
- Diffuse goiter
- Infiltrative opthalmopathy
- Infiltrative dermatopathy (caused by increased levels of ______ ____) –> look for periorbital swelling.
Hyaluronic Acid
_______ thyroiditis is the most common cause of goiter in the US (iodine deficiency is the most common cause worldwide). It is caused by autoimmune dysfunction and is therefore ______ (painful or painless?). The thyroid appears diffuse, nontender, rubbery thyroid enlargement with a _____ cut surface.
Painless
Flashy cut surface
Hashimoto thyroiditis presents histologically with a triad of findings:
- ____ infiltrate
- ____ follicles with germinal centers
- ____ cell metaplasia of follicular epithelium.
There is HIGH risk for ___-cell lymphoma, ______ carcinoma, and ______ cell neoplasm.
Look for _______ and _______ antibodies for diagnosis.
- Lymphocytic infiltrate
- Lymphoid follicles
- Hurthle cell metaplasia
B-cell lymphoma
Papillary carcinoma
Hurthle cell neoplasm
Anti-microsomal and Anti-thyroglobulin (it is autoimmune after all!)
Subacute thyroiditis is _______ (unlike Hashimoto), and usually follows upper respiratory viral infection. Remember progression is from Hyper, to Eu, to Hypothyroidism in the healing process.
Painful
______ thyroiditis presents as a stony hard, painless thyroiditis.
Riedel’s thyroiditis
“Hot” thyroid nodules are more likely to be ______. Nodules in younger patients are more likely to be ______, as are nodules in _____ (which sex?).
Benign
Neoplastic
Males
Thyroid neoplasm is the most common endocrine malignancy. It is more common in _____ (sex?) and is associated with previous radiation of neck or endemic ______.
Patients usually present with ______ thyroid function.
____ ____ ____ biopsy is the most important diagnostic tool.
Women
Goiters
Normal
Fine Needle Aspiration biopsy
The difference between Follicular adenoma and Follicular carcinoma is the latter will show _____ and/or _____ invasion.
About 20% of Follicular adenomas are associated with a point mutation in ____ genes.
Vascular and/or Capsular
RAS
Hurthle cell tumors are Follicular neoplasms that can be diagnosed by looking at the cut surface. How will it appear?
Brown (remember Hashimoto’s will have a flashy cut surface.)
Papillary thyroid carcinoma is associated with ______ mutation in 1/3-1/2 of cases. Histologically, cells will have _______ nuclei with intracellular inclusions.
BRAF
Clear
Prognostic factors of Papillary thyroid carcinoma:
S A G E S –> What do the letters stand for?
Sex –> women better prog than men
Age –> younger = better prog
Grade –> dedifferentiation = poor prog
Extent –> beyond thyroid = poor prog
Size –> big = bad
20% of Medullary thyroid carcinomas are associated with ____ 2A or 2B syndrome. Remember that Medullary thyroid carcinoma cells are positive for ______.
MEN 2A or 2B
Calcitonin
________ thyroid carcinoma is the most fatal.
Anaplastic
