Pathology of the thryroid and parathyroid Flashcards
what is type of euthyroid goitre is found in younger people
diffuse
multinodular in older people
what substances can cause hypothyroidism
iodine deficiency
lithium and amiodarone
cabbage, turnips and seaweed
what are the features of malignant thyroid nodules
hard nodule, fixed to surrounding tissue and regional lymphadenopathy
signs of local nerve involvement (dysphagia and hoarseness)
what do thyroid function tests measure
level of TSH
high- thyroiditis
low: autonomous/hyper functioning nodule
how do you investigate a thyroid nodule
thyroid function tests, antithyroid antibodies
complete blood count
fine needle aspirate
ultrasound
radioiodine scintigraphy
chest radiography (look for lung metastases)
CT and MRI
what is Grave’s disease
may present as diffuse toxic goitre autoimmune more common in females IgG against TSH receptor on thyrocytes strong family history
what demographic is most likely to get hashimoto thyroiditis
females 30-50
what are the features of hashimotos thyroiditis
autoreactive CD8 T lymphocytes
strong family history
what is a follicular adenoma
benign encapsulated tumor of the thyroid gland
30-50 years old
name some possible malignancies of the thyroid
papillary, follicular, anaplastic, medullary, lymphoma
what is the most common type of thyroid cancer
papillary carcinoma
20-50 years old
may be caused by radiation
what genes are involved in papillary carcinomas
RET oncogene rearrangement
B-RAF mutation which is associated with increased risk of mets
what cancer accounts for 20% of thyroid cancers
follicular carcinoma
older than 40
RAS oncogene
PAX8/PPARG rearrangements
usually minimally invasive
what are the features of anaplastic carcinomas
half have had previous chronic goitre
may have had a previous thyroid neoplasm
p53 mutation common
poor prognosis due to low differentiation
what are the features of a medullary carcinoma
sometimes familial
RET proto-oncogene activation
originates from parafollicular cells which produce calcitonin
what is the most common cause of primary hyperparathyroidism
parathyroid adenoma
what can cause primary hyperparathyroidism
hyperplasia
parathyroid carcinoma
what causes secondary hyperparathyroidism
low calcium
chronic renal failure and vitamin D deficiency
what is tertiary hyperparathyroidism
raised calcium in secondary hyperparathyroidism
what are the symptoms of hypercalcaemia
emotional disorders parathyroid adenoma or hyperplasia muscle atrophy osteitis fibrosa cystica peptic ulcer pancreatitis kidney stones nephrocalcinosis
what is Multiple endocrine neoplasia
tumours grow in endocrine glands:
pituitary, parathyroid, pancreatic, adrenal glands
what is osteoitis fibrosa cystica
caused hyperparathyroidism which causes bone break down and raised calcium levels
