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MD4001 Week 9 > Pathology of the Thyroid and Parathyroid Glands > Flashcards

Pathology of the Thyroid and Parathyroid Glands Flashcards

1
Q

What are the clinical presentation of thyroid pathologies?

A

Goitre

Lump

Hyper or hypothyroidism

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2
Q

What goitre is most likely to present in younger people?

A

Diffuse swelling in younger

Multinodular in older

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3
Q

What are the hypothyroid causes of goitre?

A

Iodine deficiency- endemic

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

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4
Q

What can cause goitre with excess iodine?

A

Seaweed consumption

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5
Q

What is the pathogenesis of goire?

A

Can be reactive

Iodine block

Genetic susceptibility

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6
Q

Mechanism of goitrogens?

A

Inhibition of normal function in thyroid causing the swelling

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7
Q

How do benign masses in the thyroid present?

A

Movable

Soft

Non tender

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8
Q

How do malignant masses in the thyroid present?

A

Hard nodule

Fixation to surrounding tissue

Regional lymphadenopathy

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9
Q

Symptoms of hyperthyroidism?

A

Nervousness

Heat tolerance

Diarrhoea

Muscle weakness

Loss of weight and appetite

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10
Q

Symptoms of hypothyroidism?

A

Cold intolerance

Constipation

Fatigue

Weight gain

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11
Q

What causes weight gain in children due to hypothyroidism?

A

Myxedematous fluid

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12
Q

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

A

Local invasiveness from malignancy

Signs are dysphagia and hoarseness

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13
Q

How can you diagnose thyroid issues?

A

Thyroid function tests

Antithyroid antibodies

Complete blood count

Fine needle aspirate

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14
Q

What can TFT show?

A

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

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15
Q

What can ATA show?

A

Helpful in diagnosing chronic lymphocytic thyroiditis (Hashimoto thyroiditis)

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16
Q

What can CBC show?

A

Abscess

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17
Q

What imaging can you do for thyroid pathologies?

A

Ultrasonography

Radioiodine scintigraphy

Chest radiography

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18
Q

Why would you use ultrasonography

A

To determine whether the nodule is cysts, solid or mixed

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19
Q

Why would you use radioiodine scintigraphy?

A

To determine whether the nodule is cold ,warm or hot

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20
Q

Why would you use chest radiography?

A

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

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21
Q

What are the different diseases of thyroid?

A

Trauma and toxicity

Goitre, solitary nodule, neoplasms

Chronic inflammation

Acute thyroiditis, abscess

Metabolic, genetic

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22
Q

How does hyperthyroidism present?

A

Muscle wasting

Fine hair

Exophthalmos

Goiter

Sweating

Tachycardia

Weight loss

Oligomenorrhea

Tremor

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23
Q

What is the most commonest cause of hyperthyroidism?

A

Graves

24
Q

What can cause hyperthyroidism?

A

Graves

Functional goitre

Toxic adenoma

25
Q

How does hypothyroidism present?

A

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

26
Q

What can cause hypothyroidism?

A

Congenital

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

27
Q

What can Graves present as?

A

Diffuse toxic goitre

28
Q

What is autoimmune response causing Graves?

A

IgG against TSh receptor on thyrocytes

Strong family history HLA DR3 and CTLA-4

29
Q

What is the autoimmune response causing Hashimoto thyroiditis?

A

Autoreactive CD8 T lymphocytes

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

30
Q

What are causal risk of Hashimoto thyroiditis?

A

Increased iodine intake

Viral infection

31
Q

How does Hashimoto thyroiditis present?

A

Hyper or hypo thyrodism

32
Q

What are benign neoplasms called?

A

Follicular adenoma

33
Q

What are the malignant neoplasms?

A

Papillary

Follicular

Anaplastic

Medullary

Lymphoma

34
Q

What are the metastatic neoplasms that develop in the thyroid?

A

Lymphoma

35
Q

Why does Hashimoto cause hypothyroidism?

A

Damage to follicles early on in the disease

36
Q

Who does follicular adenoma present in?

A

30-50 years

Females over males

1-3cm in size at presentation

37
Q

What is the long term risk of Hashimoto?

A

Lymphoma due to overstimulation of lymphoids

38
Q

What is the most common neoplasm of thyroid?

A

Papillary carcinoma

39
Q

Who does papillary carcinoma present in?

A

20-50 years

Females 3:1 males

40
Q

What are the causes of papillary carcinoma?

A

Radiation

Family history

Unknown

41
Q

Mechanism of papillary carcinoma?

A

Rearrangement of RET oncogene in most

B-RAF mutation in half- associated with increased risk of LN mets

42
Q

What makes up 20% of thyroid cancer?

A

Follicular carcinoma

43
Q

Who does follicular carcinoma present in?

A

Older than 40

Female 3:1 male

44
Q

What causes follicular carcinoma?

A

RAS oncogene

PAX8/ PPARG rearrangements

45
Q

Describe follicular carcinoma?

A

Minimally invasive versus invasive

Can spread through blood

46
Q

Who does anaplastic carcinoma present in?

A

Female: male 4:1

Half have had chronic goitre

May have had previous thyroid neoplasia

47
Q

What can cause anaplastic carcinoma?

A

p53 mutation common

48
Q

What causes medullary carcinoma?

A

RET proto-oncogene activation

49
Q

What can anaplastic carcinoa develop from?

A

Papillary carcinoma

Follicular carcinoma

Through p53 mutation

50
Q

What causes follicular cell to toxic adenoma?

A

TSH-R

Gsp

51
Q

What causes primary hyperparathyroidism?

A

Adenoma

Hyperplasia

Parathyroid carcinoma

52
Q

What causes secondary hyperparathyroidism?

A

Caused by low calcium

  • chronic renal failure
  • vitamin D deficiency
53
Q

What causes tertiary hyperparathyroidism?

A

Raised calcium in secondary caused by an over correction

54
Q

What are the hypercalcaemia effects?

A

Muscle atrophy

Emotional disorders

Parathyroid adenoma or hyperplasia

Hypercalcemia

Osteitis fibrosa cystica

Peptic ulcer

Pancreatitis

Kidney stone

Nephrocalcinosis

55
Q

What are the different locations for multiple endocrine neoplasia?

A

Pituitary

Nerves

Parathyroid

Thyroid C cells

Bronchial carcinoid

Enteropancreatic

Adrenal chromaffin

56
Q

Function of parathyroid hormone?

A

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

MD4001 Week 9 (8 decks)

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