Non Neoplastic Thyroid disease

Question 1

Ectopic or pathologic thyroid may seen anywhere along what pathway in adult life?

Answer 1

thyroglossal duct

Question 2

Where does the thyroglossal duct begin?

Answer 2

Foramen cecum

Question 3

Where is lingual thyroid?

Answer 3

Mass in foramen cecum of tongue

Question 4

How may lingual thyroid present?

Answer 4

dysphagia, dyspnea, dysphonia

Question 5

Is lingual thyroid rare or common?

Answer 5

Rare, but the most common location of functioning ectopic thyroid

Question 6

Does lingual thyroid present in the presence or absence of cervical thyroid?

Answer 6

70% associated with abscence of thyroid

Question 7

Where does thyroglossal duct cyst usually present?

Answer 7

midline between isthmus and hyoid

Question 8

When does thyroglossal duct cyst usually present?

Answer 8

At birth or childhood

Question 9

What risks are present with thyroglossal duct cyst usually present?

Answer 9

repeated infection. Big ones can cause obstruction

Question 10

Are thyroglossal duct cysts hormonally active?

Answer 10

No

Question 11

Describe substernal goiter. What is it? How does it present?

Answer 11

thyroid tissue that has “dropped” into anterior mediastinum; seen with cervical goiter.
May be symptomatic (dyspnea, dysphagia, hyperthyroid, hypothyroid) or not

Question 12

A lateral aberrant thyroid is more likely to be what?

Answer 12

metastatic follicular thyroid carcinoma

Question 13

Describe suprahyoid/infrahyoid thyroid?

Answer 13

Similar location to thyroglossal duct cyst. Often hypothyroid with absent cervical thyroid.

Question 14

Describe struma cordis

Answer 14

Ectopic thyroid tissue in heart, usually right ventricle. Usually functions and is usually found by accident.

Question 15

What is struma ovarii?

Answer 15

Monodermal teratoma of ovary, composed mainly (>50%) of adult thyroid tissue

Question 16

Struma ovarii may functionally cause ____.

Answer 16

thyrotoxicosis

Question 17

How might struma ovarii presents?

Answer 17

woman with labs showing thyrotoxicosis but normal thyroid on exam, may be small

Question 18

Is struma ovarii malignant?

Answer 18

Adenomas are common, only 5% are malignant

Question 19

What hormonal changes are associated with early/late Hashimoto’s?

Answer 19

Early: hyperthyroid
Late: hypothyroid

Question 20

T or F. 85% of hyperthyroidism is associated with diffuse hyperplasia with Grave’s.

Answer 20

T

Question 21

How may someone with Grave’s present?

Answer 21

exopthalmos, non-pitting edema, fatigue, weight loss, increased appetite, tachycardia, muscular weakness

Question 22

Pathophys of Grave’s disease

Answer 22

Immune mediated production of TSH receptor antibodies that cause thyroid stimulation without negative feedback. Binding of Ab to other tissues causes increased GAGs with resultant tissue effects (exopthalmos, myxedema)

Question 23

How does Grave’s look on histo?

Answer 23

Hyperplastic, too many cells, heaped up epi looking like papillary, scalloped colloid due to vacuoles from increased colloid turn over

Question 24

_____ is the most common cause of hypothyroidism in north america. _____ is most common world wide.

Answer 24

Hashimotos; iodine insufficiency

Question 25

What is the automimmune etiology of Hashimotos?

Answer 25

T cell defect

Question 26

Epidemiology of Hashimoto's

Answer 26

F:M 10:1-20:1

Question 27

Hashimoto thyroiditis on histo

Answer 27

There is intense lymphocytic infiltration with tissue destruction and early fibrosis

Question 28

What is subacute thyroiditis? Epidemiology, pathophys, etc...

Answer 28

Also known as DeQuervain thyroiditis F:M is 3:1 to 5:1; season peak in summer Probably a postviral inflammatory process Not autoimmune, therefore self limited Mixed inflammatory reaction with prominent giant cell formation.

Question 29

Describe subacute lymphocytic (painless) thyroiditis

Answer 29

More common in females, without granulomas or giant cells, can be postpartum, may have HLA susceptiblity genes, could be a sub-acute hashimotos

Question 30

Describe Riedel thryoiditis

Answer 30

Unusual disorder of unknown cause Characterized by fibrosis of thyroid and other neck structures Fibrosis in distant sites (retroperitoneum) may be seen. Can be confused with cancer.

Question 31

Define goiter

Answer 31

A chronic enlargement of the thyroid gland, not due to a neoplasm, occurring endemically in certain locations, especially regions where glaciation occurred and the soil is low in iodine, and sporadically elsewhere.

Question 32

What is an endemic goiter?

Answer 32

Occurs in areas where the enviorment is low in naturally occurring iodine. Other causative factors lead to incomplete expression. Starts as diffuse enlargement but generally progress to multinodular state

Question 33

What may a big mutlinodular goiter look like grossly?

Answer 33

encase trachea, focally fibrotic and hemorrhagic suggesting multiple episodes of proliferation, hemorrhage, regression, and fibrosis

Question 34

What may a colloid nodule look like histologically?

Answer 34

internal regression with cyst formation. Band of fibrosis separates nodules.