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Endocrine > Pathology of the Thyroid Gland > Flashcards

Pathology of the Thyroid Gland Flashcards

1
Q

What are the 4 main histological classifications of thyroid cancer?

A

Papillary - 6%
Follicular - 17%
Medullary - 3%
Anaplastic - 2%

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2
Q

What does differentiated thryoid cancer refer to?

A

Papillary and Follicular thryoid cancer

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3
Q

What do most DTCs do?

A

Take up iodine and secrete thyroglobulin - can act like normal thryoid cells
They are TSH driven

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4
Q

Decribe the rates of incidence of DTC in females and males.

A

Females - Rates increase from 15-40 then plateau

Males - Steady increase with age

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5
Q

How do DTC present?

A

Majority have palpable nodules
small % are chance findings
5% with local or disseminated mets

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6
Q

Give 5 points about Papillary thyroid cancer.

A 
Associated with ionising radiation 
Usually solitary nodule 
Activates MAP kinase pathway 
Spreads via lymphatics - lungs, bone, liver and brain
Associated with Hasimoto's thyroiditis
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7
Q

Give 4 points about Folicular thyroid cancer.

A

Associated with iodine deficiency
Usually single slow growing nodule - painless and non-functional
Mutations in PI3K/AKT pathway
Spreads haematogenously

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8
Q

What is the prognosis of DTC?

A

Generally good with 10 year mortality <5%

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9
Q

What Ix are used for suspected DTC?

A

USS guided FNA

Excision biopsy of lumh node

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10
Q

What are the clinical predictors of DTC?

A 
New thyroid nodule 50 y.o 
Nodule increased in size 
Male 
Lesion >4cm 
History of head and neck irridation 
Vocal cord palsy - do pre-operative laryngoscopy
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11
Q

What exactly is the best management option for DTC?

A

Sub total thyroidectomy with RAI

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12
Q

What risk stratification tool is used post op for patients with DTC and why is this used?

A 
A - age 
M - ets 
E - extent of primary tumour 
S - Size of primary tumour
Used to stratify pts as low or high risk
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13
Q

When and why is whole body iodine scanning used?

A

Pts who have had total or sub-total thyroidectomy
Given low dose iodine capsule which will be taken up by thyroid and any DTC cells in the body to see of tumour all removed or mets

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14
Q

If uptake at thyroid bed >0.1% of ingested activity, what does the patient undergo?

A

Thyroid remnant ablation

then whole body iodine scan repeated to ensure uptake in thyroid bed now <0.1%

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15
Q

What can be used as a tumour marker in DTC?

A

Thyroglobulin - produced by DTC cells and normal thyroid cells but 0 from them as removed

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16
Q

What is a follicular adenoma?

A

Discrete solitary mass derived from thyroid follicular cells encapsulated by a surrounding collagen cuff –> very well circumbscribed

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17
Q

Is a follicular adenoma functional or non-functional?

A

Usually non-functional but can secrete thyroid hormones

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18
Q

Can medullary thyroid cancers be familial?

A

Yes (bilateral/ mulitcentric) or sporadic (solitary nodule)

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19
Q

What are medullary thryoid cancers composed of?

A

Spindle or polygonal cells arranged in nest, trabeculae or follicles

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20
Q

What can medullary thyroid cancers cause?

A

dysphagia
hoarseness
airway compromise

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21
Q

Give 4 points about Anaplastic thyroid cancer.

A

Undifferentiated and aggressive tumours
Usually older patients
May occur in pts with a history of DTC
Rapid growth and involvement of neck structures and death

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22
Q

What is the Thy scale and why is it used?

A

Thy 1 - insufficient sample
Thy 2 - benign
Thy 3 - atypia probably benign/ equivocal
Thy 4 - atypia suspicious of malignancy
Thy 5 - malignant
USS FNA used to provide a minimally invasive assessment of the likelihood of malignancy

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23
Q

What can cause primary hyperparathyriodism?

A

Adenoma involving a single gland or hyperplasia involving all glands

24
Q

What causes secondary hyperparathyroidism?

A

Chronic hypocalcaemia causes compensatory over activity of parathyroid glands

25
Q

What causes tertiary hyperparathyroidism?

A

Parathyroid activity becomes autonomous associated with hypercalcaemia

26
Q

What causes hypoparathyroidism?

A

Usually post-operatively (removal by accident)
Rarely congenital absence - DiGeorge syndrome
Familial - associated with primary adrenal insufficiency and mucocutaneous candidiasis (AI basis)

27
Q

What is the most common cause of hyper/hpothyroidism?

A

Autoimmune thyroid disease

28
Q

What blood results would you expect to see from primary hyperthyroidism?

A

TSH low

T4/T3 high

29
Q

What blood results would you expect to see from primary hypothyroidism?

A

TSH high

T4/T3 low

30
Q

What blood results would you expect to see from secondary thyroid disease - pituitary gland failure?

A

TSH low

T4/T3 low

31
Q

What blood results would you expect to see from secondary thyroid disease - TSHoma?

A

TSH high

T4/T3 high

32
Q

What blood results would you expect to see from primary subclinical hypothyroidism?

A

TSH high
T3/T4 normal
Probably end up as overt hypothyroidism

33
Q

Define hypothyroidism.

A

Results from a variety of abnormalities that cause insufficiet secretion of thryoid hormones

34
Q

What causes primary hypothyroidism?

A

Iodine deficiency #1
AI - Hashimoto’s thyroiditis #1
Hereditary biosynthetic defects
Maternally transmitted antithyroid agents, iodides
Drug induced - amiodarone, lithium, thalidomide

35
Q

What can cause secondary hypothyroidism?

A

Hypothalamic - congenital, infiltration, infection, malignancy
Pituitary - Panhypopituitarism, isolated TSh deficiency

36
Q

What are the symptoms of hypothyroidism?

A 
tiredness/ malaise 
Weight gain 
Cold intolerance 
Goitre 
Contipation 
Menorrhagia - later oligo or ammenorrhoea 
Arthralgia 
Myalgia 
Physchosis 
Poor libido
37
Q

What are the signs of hypothyroidism?

A 
Dry skin and dry thin hair 
Periorbital puffiness 
Pitting oedema 
Mental slowness 
Slow relaxing reflexes 
Carpal tunnel syndrome 
Hyperprolactinaemia 
bradycardia 
worsening of heart failure
38
Q

What Ix should be used for hypothyroidism and what would their positive result be?

A 
TSH high 
T4/T3 low 
Elevated CK 
Increases LDL cholesterol 
Hyponatraemia 
Hyperprolactinaemia 
Macrocytosis is typical – rule out a concurrent Vit B12 deficiency
39
Q

What is Hashimoto’s Thyroiditis?

A

Gradual autoimmune destruction through antibody dependent cell mediated cytotoxicity, of the thyroid gland resulting in decreased thyroid hormone production

40
Q

What autoantibodies are present in Hashimoto’s thyroiditis?

A

Anti-TPO (95%)
Anti-thyroglobulin antibody (60%)
TSH receptor antibody (10-20% - blocking)

41
Q

How is hypothyrodism managed?

A

Restore normal metabolic rate gradually
younger pts - thyroxine at 50-100mcg daily
elderly with history of IHD - thyroxine at 25-50mcg daily - adjusted every 4 weeks according to response

42
Q

In pregnancy the dose requirements of thyroxine increaaase by how much?

A

25-50% (increased TBG)

43
Q

Who is usually affected by a myxoedema coma?

A

Elderly women with longstanding but frequently unrecognised/ untreated hypothyrodisim

44
Q

How does a myxoedema coma present?

A

bradycrdia

type 2 respiratory failure

45
Q

If a patient is on amiodarone, what should they have checked frequently?

A

TFTs

46
Q

List some causes of Hyperthyroidism

A 
Graves disease 
Multi-nodular goite 
Toxic nodule (adenoma)
Subacute thyroiditis/De Quervains 
Post-partum thyroiditis 
Rare - iodine and medications (amiodarone, lithium, kelp)
47
Q

List the symptoms of hyperthyroidism.

A 
Tremor 
Palpitations 
Sweating 
Irritability Diarrhoea 
Weight loss 
Lighter/less frequent periods 
increased appetite 
intolerance to heat
48
Q

What are the clinical signs of hyperthyriodism?

A 
Tachycardia or AF 
Proximal muscle wasting 
goitre with bruit
warm peripheries 
lid lag 
palmar erythema
onycholysis
49
Q

What are the treatment options for hyperthyriodism?

A 
Carbimazole 
Propylthiouracil 
Fluid restriction 
Radioiodine and surgery may also be considered 
Symptom Tx = beta-blocker (Propanolol)
50
Q

What positive investigations indicate Graves disease?

A

High T3/T4, low TSh
Anti-TPO +ve (70-80%
Anti-thyroglobulin +ve (30-50%)
TSH receptor antibody +ve (70-100% - stimulating)

51
Q

What additional S&S are present in Grave’s disease?

A 
Exophalmus 
Chemosis 
visual loss 
proptosis 
diplopia 
pretibial myxoedema
52
Q

What may trigger De Quervains?

A

Viral infection - other symptoms ay be present - sore throat, fever, etc)

53
Q

What blood results are seen in De Quervains?

A

T4 - high in early stage, low in late stage then normal

TSH - low in early stage, high in late stage then normal

54
Q

What treatment is required for a thyroid storm?

A 
ABCDE 
May require ventilation 
Lugol's iodine 
Glucocorticoids 
PTU 
beta-blocker 
fluids 
monitoring
55
Q

How does a thyroid storm present?

A

Respiratory and cardiac collapse
Hypertermia
Exaggerated reflexes

56
Q

What precautions should be followed if you are on radio-active iodine?

A

avoid close prolonged contact with children and pregnancy women
Avoid sharing a bed for x days
avoid pregnancy for 6-12 months
ensure not pregnant at start
high risk of hypothyroidism (esp. in Graves)

Endocrine (18 decks)

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