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D&T test 6 - endocrine, dermatology, MSK > Path: Thyroid > Flashcards

Path: Thyroid Flashcards

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Dermatology Board Prep flashcards
1
Q

What are the 2 functional cells of the thyroid

A

follicular cells, parafollicular cells

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2
Q

What do the follicular cells do

A

convert thyroglobulin into T4 and T3

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3
Q

How does thyroid hormone exert it’s effects?

A

Multi-protein hormone receptor complex binds thyroid horomone respnse elements (TREs) in target genes –> upregulated transcription

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4
Q

Thyroid effects on CHON, CHO, and lipid

A

Increased CHO and lipid catabolism (breakdown)

Stimulates protein synthesis

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5
Q

Net effect of thyroid Homo

A

increased BMR (basal mtb rate)

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6
Q

4 B’s of thyroid homo

A

Brain Development
Bone growth
BMR increase
Beta-adrenergic effects

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7
Q

What do the parafollicular cells produce? name of cell?

A

calcitonin

C-cells

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8
Q

calcitonin 2 functions

A

bone absorption of Ca++

inhibits osteoclasts

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9
Q

what is T3/T4 levels in thyrotoxicosis

A

both elevated

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10
Q

What is MC cause of primary hyperthyroidism

A

MC = Diffuse gland hyperplasia related to Graves disease

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11
Q

2 non-graves causes of primary hyperthyroidism

A

Hyperfunctinoal multinodular goiter

Hyperfunctional adenoma

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12
Q

3 causes of secondary hyperthyroidism

A

Pituitary adenoma
Exogenous thyroid hormone intake
Inflammatory conditions

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13
Q

what is most useful screening test for hyperthyroidism

A

serum TSH

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14
Q

serum TSH levels in primary and secondary hyperthyroidism

A 
primary = low
secondary = high
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15
Q

RAI uptake in hyperthyroidism?

A

increased

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16
Q

diffuse or nodular hyperplasia in graves?

A

diffuse enlargenmnt

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17
Q

Cause of graves

A

AIDz: stimulating autoAbs vs TSH receptors

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18
Q

Ig type and HSR type in Graves

A

IgG, HSR type 2

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19
Q

What causes exopthalmos in Graves

A

T cells infiltrate behind eye–> cytokine release –> fibroblast secretion of GAGs –> edema, inflammation, increased adipocytes

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20
Q

histo findings of Graves (3)

A

crowded follicular cells, scalloped colloid (decreased colloid)

*lecture only- lymphoid follicles (aggregates of lymphoid tissues)

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21
Q

TSH, T3/T4, pattern of RAI uptake in Graves

A 
TSH = low
T3/4 = high
RAI = diffuse
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22
Q

2 cuases of Secondary hypothyroidism

A

piuitary problem, TSH deficiency

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23
Q

2 causes of Teritiary hypothyroidism:

A

problem of hypothalamus, TRH deficiency

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24
Q

Primary hypothryoidism- problem with what?

A

thyroid itself

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25
Q

TSH levels in primary secondary and tertiary hypothyroidism

A

Primary: high

Secondary/tertiary: low

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26
Q

Cretinism/ Congenital hypothyroidism is usually dt?

A

Usually dt lack of iodine in childhood

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27
Q

Cretinism/ Congenital hypothyroidism can also be dt an inborn error of mtb (enzyme deficiency) - what enzyme and process?

A

thyroid peroxidase is deficient –> inability to synthesize thyroid hormone

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28
Q

What is myxedema (not pretibial)

A

Hypothyroididm in adult or older child

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29
Q

How does myxedema present

A

Progressive slowing of mental and physical activity:

Fatigue, cold intolerance, apathy

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30
Q

6 signs of myxedema

A 
Periorbital edema, 
coarsening of features, 
cardiomegaly, 
fine hair/hair loss, 
deep voice,
large tongue
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31
Q

define Thyroiditis

A

Inflammation of thyroid gland

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32
Q

MC cause of thyroiditis in iodine sufficient areas

A

Hashimotos thyroiditis

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33
Q

Hashimotos is mediated by what 5 cell types? and what HSR types

A
  1. CD8+ = HSR type 4
    1. CD4 helpers –> INFy –> macrophages
    1. Antibody-dependent cell mediated toxicity (Anti-thyroid Abs- follicular cells destroyed by NK cells) (HSR II)
34
Q

Describe Hurthle cells:

A

lymphoid aggregates in the thyroid with pink cytoplasm

35
Q

Hashimotos is associated with increased risk of what cancer type

A

Lymphoma (NHL, B-cell)

36
Q

What thyroid condtion is associated with Viral etiology with URTI

A

Subacute Granulomatous DeQuervain Thyroiditis

37
Q

gross and histo of Subacute Granulomatous DeQuervain Thyroiditis

A

gross: enlarged, tender thyroid (only one = tender)
histo: Multinucleated Giant cells surrounded by pools of colloid (granulomatous inflammation)

38
Q

CP of Subacute Granulomatous DeQuervain Thyroiditis

A

Neck pain radiating to ear, jaw, etc with swallowing

39
Q

thyroid function in Subacute Granulomatous DeQuervain Thyroiditis

A

hyper early, hypo late

40
Q

define Reidel Thyroiditis

A

thyroid replaced by fibrous tissue with inflammatory cells

41
Q

What does Reidel Thyroiditis mimic and how?

A

mimics anaplastic carcinoma through fibrosis extending to surrounding structures (penetrating capsule) –> obstructive symptoms

42
Q

Reidel Thyroiditis (Fibrosing) presents as hypo or hyper?

A

hypo

43
Q

What does a goiter signify

A

Reflects impaired synthesis of thyroid homo

44
Q

Pathology of Endemic form of goiter

A

low iodine–> decreased T3/4–> increased TSH –> follicular cell hypertrophy/plasia

45
Q

Pathology of Sporadic form of goiter

A

cruciferous veggies interfere with thyroid homo synth

or hereditary enzyme defects

46
Q

in a Diffuse non-toxic goiter, what do problems arise from and notable not arise from

A

Problems arise from mass effects (no hormone dysregulation)

47
Q

What causes a multinodular goiter

A

Repeated stimulation, involution episodes –> multilobulated, assymetrical glands

48
Q

multinodular goiter:
homo level
RAI uptake
problems arise from

A

homo= euthyroid
RAI = uneven (duh - nodules)
problems arise from mass effect

49
Q

What is Plummer syndrome =

A

hyperfuncitoning nodule in the setting of multinodular goiter

50
Q

Which is more likely neoplastic: solitary or multiple nodules

A

Solitary nodules more likely neoplastic

51
Q

In what age are nodules more likely neoplastic

A

Nodules in younger patients (<40) more likely neoplastic

52
Q

In what gender are nodules more likely neoplastic

A

males

53
Q

Are”Hot” nodules (take up radioactive iodine) more likely neoplastic or benign.

A

benign

54
Q

What is used to dx all thyroid nodules

A

Fine Needle Aspiration (FNA)

55
Q

What distinguishes thyroid adenoma from carcinoma

A

Integrity of capsule

56
Q 
thyroid adenomas:
derived from 
hot or cold nodules
benign or neoplastic
solitary or multiple
A

derived from follicular epi
usually cold
usually benign
solitary

***it breaks all the rules!

57
Q

histo chcs of thyroid adenoma (2)

A 
Uniform, small follicles with colloid
hurthle cells (pink fluffy)
58
Q

4 types of CA of thyroid from most to least common

A 
Papillary CA (MC)
Follicular CA (10-20%)
Medullary CA (5%)
Anaplastic CA (<5%)
59
Q

Age and gender of Papillary CA

A

20-50

F > M

60
Q

risk factor for papillary CA

A

prior ionizing radiation

61
Q

mutation assc with papillary CA (2)

A

RET, BRAF (both protoncogenes)

62
Q

Papillary CA behavior?

A

tends to invade LNs

63
Q

how to Dx papillary CA

A

nuclear features:

  1. “Orphan Annie eye” nuclei - empty nuclei devoid of nucleoli (clear)
  2. Nuclear grooves
  3. intranuclear inclusions
  4. Psammoma bodies
64
Q

px of papillary CA

A

excellent

65
Q

Prognsosis of Follicular CA depends on?

A

mount of invasion at diagnosis

66
Q

Follicular CA likes what type of mets

A

hematogenous spread

67
Q

how to dx follicular CA?

A

invasion through capsule (vs thyroid adenoma)

68
Q

10 year survival of follicular CA

A

50%

69
Q

Medullary Carcinoma of Thyroid derived from what?

A

parafollicular C-cells

70
Q

Medullary Carcinoma of Thyroid produces?

A

produces calcitonin

71
Q

Medullary Carcinoma of Thyroid histo

A

sheets of cells in amyloid stroma (dense acellular material)

72
Q

Medullary Carcinoma of Thyroid:
mutations (2)
familiar syndrome associations (3)
which is most aggressive?

A

FTMC gene mutation = indolent
mutation in RET:
MEN2A = intermediate
MEN2B = aggressive (mets)

73
Q

Sporadic form of medullary CA present how? age

A

40-60

mass effect: dysphagia, hoarseness, cough

74
Q

What is mnemonic for medullary CA

A

“Larry, Amy, Toni” =
meduLARRY
AMYloid stroma
secretes calciTONIn

75
Q

Anaplastic CA px

A

terrible: mortality rate approaching 100%

76
Q

Histo of Anaplastic CA

A

Looks totally undifferentiated

77
Q

Anaplastic CA : age

A

older pop ~65

78
Q

CP of anaplastic CA

A

rapidly enlarging Mass effect in neck

79
Q

Tx of lymphoma

A

complete thyroidectomy

80
Q

Lymphoma of thyroid is assc with?

A

Hashimotos thyroiditis

D&T test 6 - endocrine, dermatology, MSK (22 decks)

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