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Clin Med - Endocrine > Lecture 8 - Path of Thyroid/Parathyroid > Flashcards

Lecture 8 - Path of Thyroid/Parathyroid Flashcards

1
Q

Graves’ disease

A

common cause of hypERthyroidism

diffuse goiter

TSH suppression

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2
Q

What are the sxs of hyperthyroidism?

A

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

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3
Q

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

A

TSH suppression

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4
Q

What are the sxs of hypothyroidism?

A

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

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5
Q

What disease typically result in hypothyroidism?

A

Hashimoto’s (Thyroiditis)
atrophy
surgery
iodine deficiency

Developmental disorders: aplasia of thyroid

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6
Q

How on labs is hypothyroidism dx?

A

high TSH

often >100 mU/L before sxs

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7
Q

Goiter definition

A

thyroid enlargement –usually asymptomatic

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8
Q

What sxs might you see with goiters?

A

hoarseness
dysphasia
dyspnea
facial edema

this is d/t the compression of the surrounding structures

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9
Q

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

A

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

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10
Q

What are the two common autoimmune thyroiditis?

A

Graves (hypER)

Hashimoto’s (hypO)

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11
Q

De Quervian

A

rapid painful enlargement of the thyroid

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12
Q

What is the epi of Grave’s disease?

A

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

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13
Q

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

A

diffuse

might also see ophthalompathy and skin manifestations

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14
Q

What is the epi of Hashimoto’s Thyroiditis?

A

similar to Graves’

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

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15
Q

Hashimoto’s has an increased risk of ____

A

thyroid lymphoma and papillary carcinoma

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16
Q

What is the first line treatment for Graves’?

A

NOT surgery

start with hormones

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17
Q

What is the first line treatment for Hashimoto’s?

A

NOT surgery

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18
Q

Chronic iodine deficiency will present as what type of goiter?

A

multinodular

19
Q

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

A

follicular cell

C-cell

20
Q

Follicular Adenoma

A

common benign tumor
usually solitary, non-functional

cannot be reliably distinguished from follicular carcinoma until surgery is performed

21
Q

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

A

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

22
Q

What age group gets papillary carcinoma?

A

20-50 yrs

23
Q

What are the risk factors of papillary carcinoma?

A

childhood head and neck radiation
Hashimoto’s
certain inherited disease

24
Q

What is the most frequent malignancy of thyroid gland?

A

papillary carcinoma

25
Q

What is the prognosis of papillary carcinoma?

A

90-95% long term survival

26
Q

BRAF

A

treatable gene mutation for papillary carcinoma

27
Q

Anaplastic carcinoma

A

rare (1% of thyroid cancer)

typically in elderly

presents as large, rapidly growing neck mass

poor outcome

28
Q

Medullary Carcinoma

A

tumor of C-cells

increase calcitonin –this can be used as tumor marker after treatment

29
Q

What cell line is medullary carcinoma tumor?

A

C-cells

30
Q

Calcitonin

A

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

31
Q

Why is surgery of the parathyroid difficult?

A

the variance in location of the glands

32
Q

Where are the parathyroid glands located (ideally)?

A

on the posterior side of the thyroid

4, one on each pole

33
Q

Oxyphilic cells are seen where?

A

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

34
Q

Hyperparathyroidism can cause what?

A

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

35
Q

What hormones regulate calcium?

A

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

36
Q

What is the most common cause of elevated calcium?

A

primary hyperparathyroidism

37
Q

What labs will you see with hyperparathyroidism?

A 
increase Ca (gradually, over years) 
low or normal PO4 
high Cl 
bone density if often reduced
PTH mildly elevated
38
Q

What is primary hyperparathryoidism?

A 
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

39
Q

Kidney stones might indicate what?

A

primary hyperparathyroidism

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

40
Q

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

A

only 1!

41
Q

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

A

multiple

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

42
Q

Parathyroid cacinoma

A

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

43
Q

What is the most common cause of hypocalcemia?

A

renal insufficiency

espc if you see low albumin on labs

44
Q

What are the major differences between primary and secondary hyperparthyroidism?

A

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

Clin Med - Endocrine (13 decks)

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