Lecture 8 - Path of Thyroid/Parathyroid

Question 1

Graves’ disease

Answer 1

common cause of hypERthyroidism

diffuse goiter

TSH suppression

Question 2

What are the sxs of hyperthyroidism?

Answer 2

high metabolism - weight loss, nervousness, tachycarida, heat intolerance

Question 3

How on labs can you tell if someone has Grave’s disease?

Answer 3

TSH suppression

Question 4

What are the sxs of hypothyroidism?

Answer 4

low metabolism – weight gain, lethargy, bradycardia, cold intolerance
myxedema (puffyness of the skin)

Question 5

What disease typically result in hypothyroidism?

Answer 5

Hashimoto’s (Thyroiditis)
atrophy
surgery
iodine deficiency

Developmental disorders: aplasia of thyroid

Question 6

How on labs is hypothyroidism dx?

Answer 6

high TSH

often >100 mU/L before sxs

Question 7

Goiter definition

Answer 7

thyroid enlargement –usually asymptomatic

Question 8

What sxs might you see with goiters?

Answer 8

hoarseness
dysphasia
dyspnea
facial edema

this is d/t the compression of the surrounding structures

Question 9

What is the workup for a patient with an enlarged thyroid?

Answer 9

US (most sensitive imaging modality for thyroid)
determine if it’s diffuse, nodule, ect.

Sample:
FNA - fine needle aspiration –> cytology evaluation done by pathologist, radiologist, or endocrinologist

Question 10

What are the two common autoimmune thyroiditis?

Answer 10

Graves (hypER)

Hashimoto’s (hypO)

Question 11

De Quervian

Answer 11

rapid painful enlargement of the thyroid

Question 12

What is the epi of Grave’s disease?

Answer 12

F > M
15 - 40 yrs of age
1-2/1,000

Question 13

Do you see diffuse or nodule goiter in Graves’ dz?

Answer 13

diffuse

might also see ophthalompathy and skin manifestations

Question 14

What is the epi of Hashimoto’s Thyroiditis?

Answer 14

similar to Graves’

1-2/1,000
W > M
15 - 40 yrs
diffuse goiter

Question 15

Hashimoto’s has an increased risk of ____

Answer 15

thyroid lymphoma and papillary carcinoma

Question 16

What is the first line treatment for Graves’?

Answer 16

NOT surgery

start with hormones

Question 17

What is the first line treatment for Hashimoto’s?

Answer 17

NOT surgery

Question 18

Chronic iodine deficiency will present as what type of goiter?

Answer 18

multinodular

Question 19

Which two types of cell origins are responsible for thyroid neoplasms?

Answer 19

follicular cell

C-cell

Question 20

Follicular Adenoma

Answer 20

common benign tumor
usually solitary, non-functional

cannot be reliably distinguished from follicular carcinoma until surgery is performed

Question 21

How can you tell the difference between follicular carcinoma and follicular adenoma of the thyroid?

Answer 21

you can only tell the difference via surgery since the only difference is invasion

Question 22

What age group gets papillary carcinoma?

Answer 22

20-50 yrs

Question 23

What are the risk factors of papillary carcinoma?

Answer 23

childhood head and neck radiation
Hashimoto’s
certain inherited disease

Question 24

What is the most frequent malignancy of thyroid gland?

Answer 24

papillary carcinoma

Question 25

What is the prognosis of papillary carcinoma?

Answer 25

90-95% long term survival

Question 26

BRAF

Answer 26

treatable gene mutation for papillary carcinoma

Question 27

Anaplastic carcinoma

Answer 27

rare (1% of thyroid cancer) typically in elderly presents as large, rapidly growing neck mass poor outcome

Question 28

Medullary Carcinoma

Answer 28

tumor of C-cells | increase calcitonin --this can be used as tumor marker after treatment

Question 29

What cell line is medullary carcinoma tumor?

Answer 29

C-cells

Question 30

Calcitonin

Answer 30

can be used as tumor marker after treatment in medullary carcinoma since the tumor increases calcitonin

Question 31

Why is surgery of the parathyroid difficult?

Answer 31

the variance in location of the glands

Question 32

Where are the parathyroid glands located (ideally)?

Answer 32

on the posterior side of the thyroid | 4, one on each pole

Question 33

Oxyphilic cells are seen where?

Answer 33

in the parathyroid glands --supply the chief cells with energy so they can make parathyroid hormone

Question 34

Hyperparathyroidism can cause what?

Answer 34

parathormone causes bone resorption which indirectly stimulates calcium absorption in intestine --> hypercalcemia hypercalcemia: - calcifications of soft tissues, organs - hypercalcuiuria, renal stones - functional changes: heart contraction irregularities, muscle weakness

Question 35

What hormones regulate calcium?

Answer 35

PTH (parathyroid hormone) 1,25 dihydroxyvitamin D (calcitriol) PTHrP (parathyroid hormone related peptide) calcitonin

Question 36

What is the most common cause of elevated calcium?

Answer 36

primary hyperparathyroidism

Question 37

What labs will you see with hyperparathyroidism?

Answer 37

``` increase Ca (gradually, over years) low or normal PO4 high Cl bone density if often reduced PTH mildly elevated ```

Question 38

What is primary hyperparathryoidism?

Answer 38

``` inappropriate overproduction of PTH relatively common (25-30/100,000) ``` majority of cases asymptomatic or have mild neurologic sxs (40%) usually discovered by high calcium on routine lab tests

Question 39

Kidney stones might indicate what?

Answer 39

primary hyperparathyroidism | although it only happens in 5% of cases, it is once of the manifestations of hyperparathyroidism

Question 40

If a patient has a parathyroid gland adenoma, how many glands are typically involved?

Answer 40

only 1!

Question 41

If a patient has parathyroid gland hyperplasia, how many glands are typically involved?

Answer 41

multiple usually impossible to distinguish from adenoma by examination if only one gland is involved

Question 42

Parathyroid cacinoma

Answer 42

RARE high Ca levels locally aggressive, attaches to thyroid --might have to remove thyroid lobe

Question 43

What is the most common cause of hypocalcemia?

Answer 43

renal insufficiency espc if you see low albumin on labs

Question 44

What are the major differences between primary and secondary hyperparthyroidism?

Answer 44

Primary: - increased Ca2+ - PTH x1-2 - mild or absent bone disease - adenoma path - tx: surgery Secondary: - decrease Ca2+ - PTH x5-20 - severe bone disease - hyperplasia path - tx: underlying cause