Lecture 16 - Parathyroid and Thyroid Pathology

Question 1

Normal serum PTH ranges from ___-____nM

Answer 1

10-65nM

Question 2

Granulomatous disease causes Hypercalcemia with decreased PTH bc Macrophages release _______.

Answer 2

Calcitriol (active D3)

Question 3

Patients with Hyperparathyroidism can present with ____ ____ ____ in long bones (brown tumor - solid tumor - in craniofacial bones), which leaves the bone more susceptible to fracture.

Answer 3

Osteitis Fibrosa Cystica

Question 4

How many of the Parathyroid glands are typically involved in Parathyroid adenomas?

Answer 4

1

Question 5

One of the histological Hallmarks of Parathyroid adenoma is the absence of ______.

Answer 5

Fat

Question 6

How many of the parathyroid glands are typically involved in Parathyroid Hyperplasia? How does this compare to Parathyroid adenoma?

Answer 6

All of them

Parathyroid adenoma typically only involves 1.

Question 7

15% of parathyroid Hyperplasias are a result of a mutation in _____ but not ______.

Answer 7

MEN 2A

but NOT Men 2B

Question 8

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.

Answer 8

Vascular

Question 9

Is it free, bound, or total Thyroid hormone in plasma that exerts negative feedback on AP and Hypothalamus?

Answer 9

Only Free

Question 10

The most common site of heterotropic thyroid is at the base of the _____.

Answer 10

Tongue

Question 11

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.

Answer 11

Thyroglossal duct

Respiratory epithelium

Papillary thyroid cancer

Question 12

Hypothyroidism in infants can present with ______ (delayed mental development, prominent tongue, and blank face).

Answer 12

Cretinism

Question 13

Graves’ disease is characterized by a triad of clinical findings:

1. Diffuse goiter
2. Infiltrative opthalmopathy
3. Infiltrative dermatopathy (caused by increased levels of ______ ____) –> look for periorbital swelling.

Answer 13

Hyaluronic Acid

Question 14

_______ 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.

Answer 14

Painless

Flashy cut surface

Question 15

Hashimoto thyroiditis presents histologically with a triad of findings:

1. ____ infiltrate
2. ____ follicles with germinal centers
3. ____ cell metaplasia of follicular epithelium.

There is HIGH risk for ___-cell lymphoma, ______ carcinoma, and ______ cell neoplasm.

Look for _______ and _______ antibodies for diagnosis.

Answer 15

1. Lymphocytic infiltrate
2. Lymphoid follicles
3. Hurthle cell metaplasia

B-cell lymphoma

Papillary carcinoma

Hurthle cell neoplasm

Anti-microsomal and Anti-thyroglobulin (it is autoimmune after all!)

Question 16

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.

Answer 16

Painful

Question 17

______ thyroiditis presents as a stony hard, painless thyroiditis.

Answer 17

Riedel’s thyroiditis

Question 18

“Hot” thyroid nodules are more likely to be ______. Nodules in younger patients are more likely to be ______, as are nodules in _____ (which sex?).

Answer 18

Benign

Neoplastic

Males

Question 19

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.

Answer 19

Women

Goiters

Normal

Fine Needle Aspiration biopsy

Question 20

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.

Answer 20

Vascular and/or Capsular

RAS

Question 21

Hurthle cell tumors are Follicular neoplasms that can be diagnosed by looking at the cut surface. How will it appear?

Answer 21

Brown (remember Hashimoto’s will have a flashy cut surface.)

Question 22

Papillary thyroid carcinoma is associated with ______ mutation in 1/3-1/2 of cases. Histologically, cells will have _______ nuclei with intracellular inclusions.

Answer 22

BRAF

Clear

Question 23

Prognostic factors of Papillary thyroid carcinoma:

S A G E S –> What do the letters stand for?

Answer 23

Sex –> women better prog than men

Age –> younger = better prog

Grade –> dedifferentiation = poor prog

Extent –> beyond thyroid = poor prog

Size –> big = bad

Question 24

20% of Medullary thyroid carcinomas are associated with ____ 2A or 2B syndrome. Remember that Medullary thyroid carcinoma cells are positive for ______.

Answer 24

MEN 2A or 2B

Calcitonin

Question 25

________ thyroid carcinoma is the most fatal.

Answer 25

Anaplastic