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1
Q

primary hyperthyroidism

A

thyroid gland is over functioning

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2
Q

secondary hyperthyroidism

A

gland is hyperfunctioning because it is being OVERSTIMULATED BY TSH, reflecting a primary problem in pituitary gland

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3
Q

Tertiary hyperthyroidism

A

too much TSH because there is too much hypothalamic TRH

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4
Q

Hyperthyroidism (signs and symptoms)

A
  • hypermetabolism: weight loss, muscle atrophy, heart intolerance, increased appetitie

–> young female or middle age man (use a fan, use restroom a lot)

  • Enhanced epinephrine effect shows as tremulousness and anxiety

–> a very fine fluttering speaks for hyperthyroidism

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5
Q

Lid lag

A

delay in downward movement of the upper eyelide as tha patient looks down

  • it is enhanced by the opthalmopathy of GRAVES DISEASE
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6
Q

atrial fibrillation

A

is particularly likely to result from hyperthyroidism

(younger female)

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7
Q

Thyroid storm

A
  • is the most dreaded problem in hyperthyroidism
  • this development of extreme metabolism, leading to coma and death, when the hyperthyroid patient is subjected to some other major phsyiologic stress
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8
Q

Graves Disease***

A
  • Autoimmune, with production of a IgG antibody directed against TSH receptor binding domain

–> TSH receptor autoantibodies (TRAb) (continuous stimulation of TSH receptor)

  • HIGH T3 and T4, low TSH
  • Female to male ratio: 5:1

_** DIFFUSE, SYMMETRICAL BEEFY RED GLAND**_

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9
Q

Symptoms of graves disease

A
  • usual LID LAG of hyperthyroidism
  • weak eye muscles
  • excess collagen and ground substance behind the eyeball

** RESULTING IN PROPTOSIS/EXOPHTHALMOS** (angry eyes)

  • usually antibodies against both eye mucles and the fibroblasts behind the eye
  • PRETIBIAL MYXEDEMA = myxedema-like nodules confined to anterior aspects of the lower extremitiets (autoantibodies against fibroblasts) (RARE)
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10
Q

describe teh microscopic description of GRAVES DISEASE

**

A
  • Hyperplastic follicles with papillary infolding (finger projections)
  • Pale colloid with resorption vacuoles (SCALLOPING)
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11
Q

Hypothyrodism: signs and symptoms

A

- Slowing of mind and body is prime problem (LADIES)

  • mental slowness, fatigue, irritability, and loss of interest may be mistaken for, and treated as depression
  • down syndrome patients often get lymphocytic thyroiditis, and they may end up hypothyroid
  • Myxedema: accumulation of hydrophilic ground substance throughout the connective tissue of the body (NO NODULES)

–> leads to coarsening of the facial features, enlargement of the tongue, puffiness around the eyes, and deepening and croaking of the voice

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12
Q

Cretinism signs and symptoms

A
  • HYPOthyrodism presenting first in infancy or childhood
  • CHARACTERISTICS: STUNED GROWTH (short stature), RETARDED MENTAL DEVELOPMENT, delayed bone and tooth development
  • DISTICT FEATURES

–> facial swelling, puffy eyelids, protruding tongue, low hair line, altered eyebrows

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13
Q

Cretinism tx

A
  • These people reamin like small children both mentally and physically throughout their lives

–> replacing thyroid hormoen later in life helps, but DOES NOT revers the damage

–> for BEST RESULTS, YOU MUST TREAT BEFORE THE 3rd WEEK

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14
Q

Hashimoto thyroiditis

A
  • common, chronic, progressive thyroid disease
  • Deficiency in Treg (regulatory T cells)
  • can be triggered by viral infection –> induces HLA Dr antigen expression
  • prototypical example of autoimmune disease
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15
Q

describe gross and micro anatomy of Hashimoto thyroiditis *********

A
  • GROSS: DIFFUSELY ENLARGED THYROID, capsule is intact and well dmearcated; CUTTING SURFACE is PALE, yellow-tan, FIRM
  • MICRO STRUCTURE:
  • MONONUCLEAR INFLAMMATORY INFILTRATES
  • Well-developed germinal centers
  • Thyroid follicles are atrophic and are lined in many areas by epithelial cells distinguished by the presence of HURTHLE CELLS
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16
Q

Describe Hurthle cell

A
  • abundant eosinophilic, granular cytoplasm
  • metaplastic response (metaplasia) of the normal low cuboidal follicular epithelials to ongoing injury
17
Q

De Quervain (subacute granulomatous) thyroiditis

A
  • generally secondary to viral infecty by mumps, adenoviruses, echo, coxsacki

**PAINFUL******

  • transient hyperthyroidism - wks to months goes away by itself

Pathology: granulomas with giant cells, macrophages, lymphocytes and destroyed thyroid follicules (low yeild)

CLINICAL: increased ESR rate, transient increase of T3/T4 and decreased TSH

18
Q

GOITER***********

A
  • THYROIDS ABILITY TO PRODUCE THYROID HORMONE IMPAIRED–> INCREASED TSH –> MAINTENANCE OF EUTHYROID STATE
  • Non-nodular enlargement of gland (at first and can become nondular)
  • 8:1 ratio in women vs men
  • Due to LOW IODIDE, decreased T3/T4 and compensatory increase of TSH, with resulting gland growth

–> secondary to goitrogenic foods: cabbage, cauliflower, brussels sprouts, turnips

19
Q

Colloid Goiter –> Multinodular goiter

A
  • Colloid goiter is a forerunner of nodular goiter
  • Multinodular goiter

–> increased size and lobulation of gland

–> must be differentiated from neoplasm (without capasule)

–> 50% of cases result in toxic nodular goiter resembles thyrotoxicosis of graves dieases without exophthalamos or dermatopathy

Pathology = colloid rich follicles of varying sizes with flattened epithelium

–> nodules, hemosiderin, hemorrhage, calcification

20
Q

Describe hot and cold noduels

A
  • Cold nodules = in the thyroid gland are palpable mass lesions that FAIL TO TAKE UP RADIOLABELED IODINE during nuclear scans
  • HOT NODULES are palpable mass lesions that are hyperfunctioning and accumulate INCREASED AMOUNTS OF RADIOIODINE relative to surround normal during a scan
  • FIne needle aspiration biopsy of cold nodules is commonly use to help distinguish benign thyroid conditions from more serious thyroid cancers that require surgical removal
21
Q

Thyroid adenomas

A
  • most patients are adults, and there is modest femal preponderance
  • thyroid adenomas have virtually NO TENDENCY to turn malignant
  • Typical adenoma is a solitary SPHERICAL ENCAPSULATED lesion that is demarcated from surrounding thyroid parenchyma by well defined, INTACT CAPSULE
22
Q

describe the categories of thyroid cancer

A
  • Papillary = large majority will NOT DIE; can be cured (65% of cancers)
  • follicular = maybe 50% will eventually die of it if it is frankly invasive
  • medullary = 50% 5-year mortality if sporadic

- anaplastic = ALL WILL DIE of it in short order

endo 1 (17 decks)

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