Pathology of the Thyroid I

Question 1

thyroid axis

Answer 1

hypothalamus - TRH
anterior pituitary - TSH
thyroid - T3 and T4

T3 and T4 negative feedback on hypothalamus and anterior pituitary

TSH receptor - GPCR

Question 2

42yo F sweating, pounding heart, weight loss, enlarged nontender thyroid, wide eye gaze

Answer 2

hyperthyroidism

Question 3

eye protrusion in graves

Answer 3

accumulation of loose CT behind eyeballs

Question 4

thyroid function testing

Answer 4

serum TSH and T4
ultrasound/radionucleotide uptake studies
serum Abs

Question 5

low TSH and high T4

Answer 5

hyperthyroid

Question 6

high TSH and low T4

Answer 6

hypothyroid

Question 7

normal thyroid

Answer 7

euthyroid

Question 8

ultrasound of thyroid

Answer 8

tells you cystic vs. solid

Question 9

toxic

Answer 9

hyperfunctioning

Question 10

elevated T3 and T4

Answer 10

thyrotoxicosis

-hypermetabolic state

Question 11

majority of hyperthyroid

Answer 11

graves disease

diffuse hyperplasia of thyroid

also caused by multinodular goiter and thyroid adenoma

Question 12

3 most common causes of thyrotoxicosis

Answer 12

graves disease**
multinodular goiter
thyroid adenoma

Question 13

T4 vs. T3

Answer 13

T3 higher activity

T4 higher levels (10:1)

Question 14

overactive sympathetics

Answer 14

with hyperthyroidism

Question 15

increased metabolism, heat intolerance, weight loss with increased appeitite, tachycardia, palpitations, cardiomegaly, anxiety, insomnia

Answer 15

hyperthyroidism

Question 16

early manifestations of hyperthyroidism

Answer 16

cardiac manifestations

tachy, palps, cardiomegaly

also atrial fib possible

complication - CHF

Question 17

low output heart failure

Answer 17

thyrotoxic cardiomyopathy

reversible left ventricular dysfunction

individuals with hyperthyroidism

Question 18

GI and hyperthyroid

Answer 18

hypermotility, diarrhea, malabsorption

Question 19

lid lag

Answer 19

seen with hyperthyroid

-due to sympathetic overstiulation of mullers muscle (superior tarsal m)

Question 20

proptosis

Answer 20

graves disease

protrusion of eyeballs

Question 21

skeletal system and hyperthyroid

Answer 21

thyroid hormone - stimulates osteoporosis and increased fracture risk

Question 22

sudden onset of severe hyperthyroid

Answer 22

thyroid storm

patient with graves disease and sudden increase in stress on body (infection, surgery,, etc.)

febrile and tachycardia

complication - untreated patient can die due to cardiac arrhythmias

Question 23

women with hypothyroid

Answer 23

don’t overtreat - can lead to osteoporosis

Question 24

teratoma

Answer 24

commonly has thyroid tissue as well**

Question 25

exopthalmos

Answer 25

graves disease

Question 26

rash on front of shins

Answer 26

pretibial myxedema | -seen in graves disease

Question 27

most common cause of endogenous hyperthyroid

Answer 27

graves disease

Question 28

graves disease

Answer 28

females age 20-40yo autoantibodies for TSH receptor - TSI

Question 29

TSI

Answer 29

thyroid stimulating immunoglobulin antibody present in graves disease** 90% of patients

Question 30

symmetrical enlargement of thyroid

Answer 30

graves disease diffuse hypertrophy and hyperplasia diffuse enlargement of thyroid**

Question 31

diffuse enlargement of thyroid

Answer 31

graves disease - also increased blood supply - may hear bruit

Question 32

beefy red thyroid, heat intolerance, palpitations, enlarged thyroid, bruit

Answer 32

graves disease

Question 33

exopthalmos with graves

Answer 33

inflammatory process causes this - glycosaminoglycan and lymphoid infiltrate deposition** tx will move eyeballs back if bad - corneal abrasions bc can't close eyelids

Question 34

sympathetic overactivity

Answer 34

wide, staring gaze and lid lag

Question 35

pretibial myxedema

Answer 35

seen in graves disease basis of this localization is not clear only in minority of patients

Question 36

diagnosis of graves disease

Answer 36

elevated T4 and T3 depressed TSH levels radioiodine scan - diffuse increased uptake of iodine

Question 37

prognosis of graves disease

Answer 37

tx - beta-blockers for sympathetic sx also to decrease thyroid hormone synthesis - thionamides, radioiodine ablation, thyroidectomy

Question 38

surgery in graves

Answer 38

if large goiter compressing surrounding structure

Question 39

42yo F weight gain, constipation, feels cold, thyroid symmetric and diffusely enlarged, TSH increased, T4 decreased

Answer 39

hypothyroid decreased uptake on radionucleotide study

Question 40

anti-TPO antibodies

Answer 40

hypothyroid | -hashimotos

Question 41

common cause of hypothyroid

Answer 41

hashimotos autoimmune destruction of thyroid anti-TPO Abs

Question 42

weight loss

Answer 42

graves

Question 43

weight gain

Answer 43

hashimotos

Question 44

graves vs. hashimotos

Answer 44

chronic inflammation in hashimotos overstimulation in graves

Question 45

pregnant women

Answer 45

hard to diagnose thyroid function

Question 46

congenital hypothyroidism

Answer 46

worldwide endemic iodine deficiency

Question 47

autoimmune hypothyroidism

Answer 47

most common in iodine sufficient areas of world

Question 48

live in mountains

Answer 48

goiter belt - central or south america eat green veggies, live in himalayas, diffuse enlargement of neck hypothyroid**

Question 49

hypothyroid in childhood

Answer 49

cretinism

Question 50

severe mental retardation, short stature, coarse facial features, protruding tongue, umbilical hernia

Answer 50

hypothyroid maternal T3 and T4 cross placenta - critical for fetal brain development

Question 51

myxedema

Answer 51

hypothyroidism in older child or adult slowing of physical and mental activity listless, cold intolerant, overweight constipation, decreased sweating (decreased sympathetics)

Question 52

atherogenic profile

Answer 52

with hypothyroidism increased in total cholesterol and LDL levels increased cardiovascular problems

Question 53

nonpitting edema, broad coarse facial features, enlarged tongue, deep voice

Answer 53

hypothyroid

Question 54

thyroiditis

Answer 54

inflammation of thyroid gland

Question 55

fibrous thyroiditis

Answer 55

reidel

Question 56

subtypes of thyroiditis

Answer 56

hashimoto - most common granuloma (de quervain) subacute lymphocytic thyroiditis

Question 57

needle aspiration of thyroid with lots of lymphocytes

Answer 57

hashimotos | -inflammatory process

Question 58

hurthle cells

Answer 58

in hashimoto thyroiditis thyroid follicle atrophy lined with epithelial cells with abundant eosinophilic granular cytoplasm

Question 59

painless enlargement of thyroid, symmetric and diffuse enlargement

Answer 59

hashimotos

Question 60

transient thyrotoxicosis

Answer 60

hypothyroid preceded by transient thyrotoxicosis in hashimotos - hashitoxicosis during this phase - T3 and T3 elevated, TSH depressed, radioactive iodine uptake decreased then later - T4 and T3 levels fall

Question 61

increased risk of developing other autoimmune disease

Answer 61

hashimotos both endocrine and nonendocrine

Question 62

increased risk for development of marginal zone B cell lymphomas in thyroid

Answer 62

with hashimotos disease

Question 63

subacute lymphocytic thyroiditis

Answer 63

middle aged women - often occurs after pregnancy -postpartum thyroiditis painless thyroiditis antithyroid peroxidase (TPO) antibodies** 1/3 individuals to overt hypothyroid over 10 year period

Question 64

granulomatous thyroiditis

Answer 64

de quervains women age 40-50yo triggered by viral infection -history of upper respiratory infection multinucleated giant cells

Question 65

upper respiratory infection followed by thyroiditis

Answer 65

granulomatous thyroiditis

Question 66

painful thyroid

Answer 66

granulomatous thyroiditis

Question 67

fibrosis involving thyroid

Answer 67

reidel thyroiditis rare disorder associated with fibrosis of retroperitoneum -manifestation of IgG4 autoimmune disease