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Endocrine > Pathology of the Thyroid > Flashcards

Pathology of the Thyroid Flashcards

1
Q

What is the cause of primary and secondary hyperthyroidism?

A 
Primary = the thyroid gland itself is over-functioning
Secondary = thyroid is overstimulated by TSH
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2
Q

What is tertiary hyperthyroidism?

A

Too much TSH because there is too much hypothalamic TRH

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3
Q

What is lid lag, and what disease is it seen in?

A

A delay in the downward movement of the upper eyelid as the patient looks down

Grave’s disease

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4
Q

What cardiac arrhythmia develops from hyperthyroidism?

A

A-fib

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5
Q

What type of autoantibody is directed against the thyroid gland in Graves’ disease? What specific part of the thyroid is this directed against?

A

IgG against the TSH receptor (also known as thyroid stimulating autoantibodies, TSAb)

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6
Q

What is the ratio of female:male incidence of Graves’ disease?

A

5:1

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7
Q

What are the T3/T4 and TSH levels in Graves’ disease?

A

High T3/T4

Low TSH

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8
Q

What causes the proptosis/exophthalmos in Graves’ disease?

A

Excess collagen/ground substance deposition behind the eyes, and antibodies directed against the eye muscles and fibroblasts behind the eye

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9
Q

Who usually exhibits pretibial myxedema: hyper or hypothyroid patients? How can you tell the difference?

A

Usually hypothyroid patients, but can occur with hyperthyroid states as well (e.g. Graves’ disease).

If in hyperthyroid states, usually confined to the shin area, and have nodules

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10
Q

What are the gross characteristics of the thyroid glad with Graves’ disease?

A

Diffuse, beefy red gland that is symmetrical

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11
Q

What are the histological characteristics of Graves’ disease? (2)

A

Hyperplasia of the follicles with papillary infoldings

Scalloping of the colloid

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12
Q

Down syndrome patients are more predisposed to developing what thyroid pathology?

A

Lymphocytic thyroiditis, with eventual hypothyroidism

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13
Q

What is myxedema?

A

Accumulation of hydrophilic ground substance throughout the connective tissue of the body

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14
Q

What gross PE findings can be found in patients with myxedema?

A

Coarsening of facial features
Macroglossia
Exophthalmos
Deepening of the voice

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15
Q

What are the distinctive facial features of Cretinism? (5)

A 
Facial swelling
Puffy eyelids
Low hair line
Protruding tongue
Altered eyebrows
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16
Q

What is the natural h/o cretinism? Does replacing thyroid hormone later in the disease process reverse the ssx?

A

Small stature and MR.

Will not reverse the ssx, but will help

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17
Q

When is it necessary to begin treating cretinism to prevent the development of cretinism?

A

Before the 3rd week

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18
Q

True or false: in the US, all babies are screened for hypothyroidism

A

True

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19
Q

Which gender is usually affected with Hashimoto thyroiditis?

A

Female adults

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20
Q

What causes Hashimoto’s thyroiditis?

A

Deficiency in Tregs, causing an increase in CTLs and activated B cells

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21
Q

What is the HLA haplotype that is associated with the development of Hashimoto?

A

HLA-DR5

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22
Q

What are the gross findings of a thyroid with Hashimoto’s?

A

Diffusely enlarged thyroid with the capsule intact and well demarcated.

Cutting surface is pale, yellow-tan, firm

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23
Q

What causes the paleness of the thyroid in Hashimoto’s?

A

Infiltration of WBCs

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24
Q

What are the histological characteristics of Hashimoto’s?

A

Mononuclear inflammatory infiltrates with well developed germinal centers

Thyroid follicles are atrophic and are lined in many areas by epithelial cells

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25
Q

What are Hurthle cells?

A

Large, eosinophilic cells with granule cytoplasm found in Hashimoto’s thyroiditis

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26
Q

What is De Quervain (subacute granulomatous) thyroiditis?

A

A thyroid viral infection that is transient and self limiting

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27
Q

What is the telltale sign of De Quervain (subacute granulomatous) thyroiditis?

A

Painful thyroid

28
Q

Who usually gets De Quervain (subacute granulomatous) thyroiditis?

A

40-50 y/o females

29
Q

What are the four most common viral causes of De Quervain (subacute granulomatous) thyroiditis?

A
  • Mumps
  • Adenovirus
  • Echovirus
  • Coxsackie
30
Q

What are the histological findings of De Quervain (subacute granulomatous) thyroiditis?

A

Granulomas with giant cells, macrophages, lymphocytes and destroyed thyroid follicles

31
Q

What happens to T3/T4 levels with De Quervain (subacute granulomatous) thyroiditis? TSH levels?

A

Increased T3/T4

Decreased TSH levels

32
Q

What causes a goiter?

A

Inability of the thyroid to produce T3/T4 for some reasons leads to an increase in TSH levels, which stimulates the growth of the thyroid gland

33
Q

What happens to goiter development over time?

A

Goes from smooth to nodular

34
Q

What is the female:male ratio of goiter development?

A

8:1

35
Q

What is the endemic cause of goiter development?

A

Low iodine levels

36
Q

What are the goitrogenic foods? Why are these goitrogenic?

A

cabbage
Cauliflower
Brussel sprouts
Turnips

Have a substance that inhibits the production of T3/T4

37
Q

How can you differentiate between a thyroid neoplasm from thyroid hyperplasia?

A

Neoplasms lack a capsule

38
Q

What are the histological characteristics of a goiter?

A
  • Colloid rich follicles of varying sizes, with flattened epithelium
  • Hemorrhage
  • Hemosiderin
  • Calcification
39
Q

What is the epithelium flattened with a goiter?

A

Increase in colloid

40
Q

What are “cold” nodules in goiters?

A

Nodules that fail to take up iodine during a nuclear scan

41
Q

What are “hot” nodules in the thyroid?

A

Nodules that take up iodine during a nuclear scan

42
Q

True or false: both benign and malignant thyroid conditions can cause a cold area on a thyroid scan

A

True

43
Q

What is the only way to obtain a biopsy of the thyroid gland?

A

Fine needle aspiration (FNA)

44
Q

Neoplastic thyroid nodules are generally hot or cold? What is the definitive way to diagnose this?

A

Usually cold, but only way to diagnose is biopsy with FNA

45
Q

Who usually gets thyroid adenomas? What is the chance of a thyroid adenoma turning into a malignant mass?

A

Adult females

Extremely low chance of becoming malignant

46
Q

What are the typical gross characteristics of a thyroid adenoma?

A

Spherical encapsulated lesion that is demarcated from the surrounding thyroid parenchyma by a well-defined, intact capsule

47
Q

What are the four types of thyroid cancer in descending order of incidence?

A

Papillary
Follicular
Medullary
Anaplastic

48
Q

What is the prognosis of a papillary thyroid cancer?

A

Good

49
Q

What is the prognosis of a anaplastic thyroid cancer?

A

Very bad

50
Q

What is the prognosis of a follicular thyroid cancer?

A

50% survival

51
Q

What is the prognosis of a medullary thyroid cancer?

A

50% 5 year mortality

52
Q

What is the most common reason for the development of papillary thyroid carcinoma?

A

Irradiation of the thyroid

53
Q

What is the risk of developing papillary carcinoma of the thyroid with radioablation of the thyroid?

A

Very small

54
Q

What are the gross and histological characteristics of papillary thyroid carcinoma?

A 
Gross = fibrovascular stalk with tumor cells
Histo = Orphan annie eye nuclei
55
Q

What are the Orphan Annie eyed nuclei found in papillary thyroid carcinoma?

A

Margination of the chromatin d/t fixation

56
Q

Nuclear grooves (AKA coffee bean nuclei) = ?

A

Papillary thyroid carcinoma

57
Q

Psammoma bodies in the thyroid are indicative of what pathological process?

A

Papillary thyroid carcinoma

58
Q

Nuclear hole in thyroid = ?

A

Papillary thyroid carcinoma

59
Q

What are the gross and histological characteristics of follicular thyroid carcinoma?

A

Gross = gray-tan, single encapsulated nodule with fibrosis, calcification

Histological = Hurthle cells in follicular pattern

60
Q

Why is the prognosis of follicular carcinoma worse than papillary? What is odd about this cancer?

A

has a higher rate of metastases

Does not met to the lymph—hematogenous spread

61
Q

What is the familial disorder that predisposed patients to the development of medullary thyroid carcinoma? What is the genetic defect in this disease?

A

MEN2

RET gene on chromosome 10

62
Q

What are the cells that are defective in medullary thyroid CA?

A

C cells

63
Q

What are the gross and histological features of medullary thyroid CA?

A

Gross = nonencapsulated mass(es)

Histological = Amyloid stroma

64
Q

What does anaplastic carcinoma of the thyroid usually arise from?

A

Previous papillary or follicular thyroid CA

65
Q

What are the histological characteristics of anaplastic thyroid CA?

A

Highly anaplastic cells with cytokeratin but TG -

Large giant cells

Endocrine (32 decks)

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