Pathology of the Thyroid and Parathyroid Glands

Question 1

What are the clinical presentation of thyroid pathologies?

Answer 1

Goitre

Lump

Hyper or hypothyroidism

Question 2

What goitre is most likely to present in younger people?

Answer 2

Diffuse swelling in younger

Multinodular in older

Question 3

What are the hypothyroid causes of goitre?

Answer 3

Iodine deficiency- endemic

Goitrogens- drugs (lithium, amiodarone), diet (cabbage, turnips)

Question 4

What can cause goitre with excess iodine?

Answer 4

Seaweed consumption

Question 5

What is the pathogenesis of goire?

Answer 5

Can be reactive

Iodine block

Genetic susceptibility

Question 6

Mechanism of goitrogens?

Answer 6

Inhibition of normal function in thyroid causing the swelling

Question 7

How do benign masses in the thyroid present?

Answer 7

Movable

Soft

Non tender

Question 8

How do malignant masses in the thyroid present?

Answer 8

Hard nodule

Fixation to surrounding tissue

Regional lymphadenopathy

Question 9

Symptoms of hyperthyroidism?

Answer 9

Nervousness

Heat tolerance

Diarrhoea

Muscle weakness

Loss of weight and appetite

Question 10

Symptoms of hypothyroidism?

Answer 10

Cold intolerance

Constipation

Fatigue

Weight gain

Question 11

What causes weight gain in children due to hypothyroidism?

Answer 11

Myxedematous fluid

Question 12

Why should local nerve involvement of a mass be investigated immediately?

Answer 12

Local invasiveness from malignancy

Signs are dysphagia and hoarseness

Question 13

How can you diagnose thyroid issues?

Answer 13

Thyroid function tests

Antithyroid antibodies

Complete blood count

Fine needle aspirate

Question 14

What can TFT show?

Answer 14

Elevation thyroid stimulating hormone level may indicate thyroiditis, a very low TSH level indications and autonomous or hyperfunctioning nodule

Question 15

What can ATA show?

Answer 15

Helpful in diagnosing chronic lymphocytic thyroiditis (Hashimoto thyroiditis)

Question 16

What can CBC show?

Answer 16

Abscess

Question 17

What imaging can you do for thyroid pathologies?

Answer 17

Ultrasonography

Radioiodine scintigraphy

Chest radiography

Question 18

Why would you use ultrasonography

Answer 18

To determine whether the nodule is cysts, solid or mixed

Question 19

Why would you use radioiodine scintigraphy?

Answer 19

To determine whether the nodule is cold ,warm or hot

Question 20

Why would you use chest radiography?

Answer 20

If malignancy is suspected, given the high incidence of early metastases to the lungs

Question 21

What are the different diseases of thyroid?

Answer 21

Trauma and toxicity

Goitre, solitary nodule, neoplasms

Chronic inflammation

Acute thyroiditis, abscess

Metabolic, genetic

Question 22

How does hyperthyroidism present?

Answer 22

Muscle wasting

Fine hair

Exophthalmos

Goiter

Sweating

Tachycardia

Weight loss

Oligomenorrhea

Tremor

Question 23

What is the most commonest cause of hyperthyroidism?

Answer 23

Graves

Question 24

What can cause hyperthyroidism?

Answer 24

Graves

Functional goitre

Toxic adenoma

Question 25

How does hypothyroidism present?

Answer 25

muscle weakness Coarse, brittle hair Loss of lateral eyebrows Myxedema madness Periorbital oedema and puffy face Pallor Large tongue Hoarseness Cardiomegaly Gastric atrophy Constipation Menorrhagia Peripheral oedema

Question 26

What can cause hypothyroidism?

Answer 26

Congenital Autoimmune- defective TH production, loss of parenchyma and deficient TSH

Question 27

What can Graves present as?

Answer 27

Diffuse toxic goitre

Question 28

What is autoimmune response causing Graves?

Answer 28

IgG against TSh receptor on thyrocytes Strong family history HLA DR3 and CTLA-4

Question 29

What is the autoimmune response causing Hashimoto thyroiditis?

Answer 29

Autoreactive CD8 T lymphocytes Autoreactive antibodies- thyroid microsomal in almost all 95% thyroglobulin in two thirds, minority have blocking TSH receptor antibodies

Question 30

What are causal risk of Hashimoto thyroiditis?

Answer 30

Increased iodine intake Viral infection

Question 31

How does Hashimoto thyroiditis present?

Answer 31

Hyper or hypo thyrodism

Question 32

What are benign neoplasms called?

Answer 32

Follicular adenoma

Question 33

What are the malignant neoplasms?

Answer 33

Papillary Follicular Anaplastic Medullary Lymphoma

Question 34

What are the metastatic neoplasms that develop in the thyroid?

Answer 34

Lymphoma

Question 35

Why does Hashimoto cause hypothyroidism?

Answer 35

Damage to follicles early on in the disease

Question 36

Who does follicular adenoma present in?

Answer 36

30-50 years Females over males 1-3cm in size at presentation

Question 37

What is the long term risk of Hashimoto?

Answer 37

Lymphoma due to overstimulation of lymphoids

Question 38

What is the most common neoplasm of thyroid?

Answer 38

Papillary carcinoma

Question 39

Who does papillary carcinoma present in?

Answer 39

20-50 years Females 3:1 males

Question 40

What are the causes of papillary carcinoma?

Answer 40

Radiation Family history Unknown

Question 41

Mechanism of papillary carcinoma?

Answer 41

Rearrangement of RET oncogene in most B-RAF mutation in half- associated with increased risk of LN mets

Question 42

What makes up 20% of thyroid cancer?

Answer 42

Follicular carcinoma

Question 43

Who does follicular carcinoma present in?

Answer 43

Older than 40 Female 3:1 male

Question 44

What causes follicular carcinoma?

Answer 44

RAS oncogene PAX8/ PPARG rearrangements

Question 45

Describe follicular carcinoma?

Answer 45

Minimally invasive versus invasive Can spread through blood

Question 46

Who does anaplastic carcinoma present in?

Answer 46

Female: male 4:1 Half have had chronic goitre May have had previous thyroid neoplasia

Question 47

What can cause anaplastic carcinoma?

Answer 47

p53 mutation common

Question 48

What causes medullary carcinoma?

Answer 48

RET proto-oncogene activation

Question 49

What can anaplastic carcinoa develop from?

Answer 49

Papillary carcinoma Follicular carcinoma Through p53 mutation

Question 50

What causes follicular cell to toxic adenoma?

Answer 50

TSH-R Gsp

Question 51

What causes primary hyperparathyroidism?

Answer 51

Adenoma Hyperplasia Parathyroid carcinoma

Question 52

What causes secondary hyperparathyroidism?

Answer 52

Caused by low calcium - chronic renal failure - vitamin D deficiency

Question 53

What causes tertiary hyperparathyroidism?

Answer 53

Raised calcium in secondary caused by an over correction

Question 54

What are the hypercalcaemia effects?

Answer 54

Muscle atrophy Emotional disorders Parathyroid adenoma or hyperplasia Hypercalcemia Osteitis fibrosa cystica Peptic ulcer Pancreatitis Kidney stone Nephrocalcinosis

Question 55

What are the different locations for multiple endocrine neoplasia?

Answer 55

Pituitary Nerves Parathyroid Thyroid C cells Bronchial carcinoid Enteropancreatic Adrenal chromaffin

Question 56

Function of parathyroid hormone?

Answer 56

Parathyroid hormone is directly involved in the bones, kidneys, and the small intestine. In the bones, PTH stimulates the release of calcium in an indirect process through osteoclasts which ultimately lead to resorption of the bones