PATH - Hyperthyroidism

Question 1

Graves disease

Answer 1

Most common cause of hyperthyroidism

• anti-TSH atb
• Type II HS rx
• diffuse goiter
• pretibial myxedema
• exophthalmos

HISTO
*Tall, crowded follicular epithelial cells; scalloped colloid

Thyroid-stimulating immunoglobulin (IgG) stimulates TSH receptors on thyroid (hyperthyroidism, diffuse goiter) and dermal fibroblasts (pretibial myxedema). Infiltration of retroorbital space by activated T-cells–> INC cytokines (eg, TNF-α, IFN-γ)–>INC fibroblast secretion of hydrophilic GAGs–>INC osmotic muscle swelling, muscle inflammation, and adipocyte count–> *exophthalmos

Question 2

Toxic multinodular

goiter

Answer 2

Focal patches of hyperfunctioning follicular cells working independently of TSH

INC release of T3 and T4

Question 3

Thyroid storm

Answer 3

Uncommon but serious complication that occurs when hyperthyroidism is incompletely treated/untreated and then significantly worsens in the setting of acute stress such as infection, trauma, surgery

SX
agitation, delirium, fever, diarrhea, coma, and tachyarrhythmia (cause
of death).

INC LFTs

Question 4

Jod-Basedow phenomenon

Answer 4

Thyrotoxicosis if a patient with iodine deficiency and partially autonomous thyroid tissue is made iodine replete.

Opposite of Wolff-Chaikoff effect.