Pathology IV

Question 1

What are the clinical findings in a patient with subacute thyroiditis (de Quervain’s)?

Answer 1

Elevated ESR, jaw pain, early inflammation, very tender thyroid (p.298)

Question 2

What is the pathology associated with Riedel’s Thyroiditis?

Answer 2

Thryoid is replaced by fibrous tissue (hypothyroid). It is considered a manifestation of IgG4 related systemic disease (p.298)

Question 3

What are the clinical findings in a patient with Riedel’s Thyroiditis?

Answer 3

Fixed, hard (rock-like), and painless goiter (p.298)

Question 4

Name five causes of hypothyroidism that are not associated with a specific disease or syndrome.

Answer 4

Congenital hypothyroidism, iodine deficiency, goitrogens, Wolff-Chaikoff effect, painless thyroiditis (p.298)

Question 5

What are the three most common causes of hyperthyroidism?

Answer 5

Toxic multinodular goiter, Graves’ disease, thyroid storm (p.299)

Question 6

What is the pathology associated with Toxic multinodular goiter?

Answer 6

Mutation in TSH receptor causing focal patches of hyperfunctioning follicular cells working independently of TSH. Hot nodules are rarely malignant (p.299)

Question 7

What lab finding is consistent with toxic multinodular goiter?

Answer 7

Increased release of T3 and T4 (p.299)

Question 8

What is the Jod-Bassedow phenomenon?

Answer 8

Thyrotoxicosis in a patient with an iodine deficiency goiter who is given significant amounts of iodine (p.299)

Question 9

What is the pathology associated with Graves’ Disease?

Answer 9

Autoimmune hyperthyroidism with thyroid stimulating immunoglobulins. It often presents during stress (childbirth, etc) (p.299)

Question 10

What are the clinical findings in a patient with Graves’ disease?

Answer 10

Opthalmopathy (proptosis, EOM swelling), pretibial myxedema, increased connective tissue deposition, diffuse goiter (p.299)

Question 11

What is characteristic in histology of a multinodular goiter?

Answer 11

Follicles distended with colloid and lined by flattened epithelium with areas of fibrosis and hemorrhage (p.299)

Question 12

What are the five cancers of the thyroid?

Answer 12

Papillary carcinoma, follicular carcinoma, medullary carcinoma, undifferentiated/ anaplastic, lymphoma (p.299)

Question 13

Which thyroid cancer is the most common and has the best prognosis?

Answer 13

Papillary carcinoma (p.299)

Question 14

What increases risk of papillary carcinoma of the thyroid?

Answer 14

Childhood irradiation (p.299)

Question 15

What is characteristic of the histology of papillary carcinoma of the thyroid?

Answer 15

Empty appearing (orphan Annie’s eyes), psammoma bodies, nuclear grooves (p.299)

Question 16

What is characteristic of the histology of follicular carcinoma of the thyroid?

Answer 16

Uniform follicles; it has a good prognosis (p.299)

Question 17

What is medullary carcinoma of the thyroid derived from?

Answer 17

Parafollicular ‘C-Cells’ (p.299)

Question 18

What conditions are associated with medullary carcinoma of the thyroid?

Answer 18

MEN types 2A and 2B (p.299)

Question 19

What is characteristic in histology of medullary carcinoma of the thyroid?

Answer 19

Sheets of cells in amyloid stroma (p.299)

Question 20

What do medullary carcinomas of the thyroid produce?

Answer 20

Calcitonin (p.299)

Question 21

What demographic patient group is most likely to have undifferentiated/anaplastic thyroid cancer and what is its prognosis?

Answer 21

Older patients; has a very poor prognosis (p.299)

Question 22

What condition presidposes patients to lymphoma of the thyroid?

Answer 22

Hashimoto’s thyroiditis (p.299)

Question 23

What causes primary hyperparathyroidism?

Answer 23

Usually an adenoma (p.300)

Question 24

What lab findings are consistent with a diagnosis of primary hyperparathyroidism?

Answer 24

Hypercalcemia, hypercalcuria (renal stones), hypophosphatemia, increased PTH, increased alkaline phosphatase, increased cAMP in urine (p.300)

Question 25

What is the most common presentation in a patient with primary hyperparathyroidism?

Answer 25

Often asymptomatic. May present with weakness and constipation (p.300)

Question 26

What is osteitis fibrosa cystica?

Answer 26

A condition where cystic bone spaces are filled with brown fibrous tissue. This causes bone pain (p.300)