Pathology of the Thyroid I Flashcards
thyroid axis
hypothalamus - TRH
anterior pituitary - TSH
thyroid - T3 and T4
T3 and T4 negative feedback on hypothalamus and anterior pituitary
TSH receptor - GPCR
42yo F sweating, pounding heart, weight loss, enlarged nontender thyroid, wide eye gaze
hyperthyroidism
eye protrusion in graves
accumulation of loose CT behind eyeballs
thyroid function testing
serum TSH and T4
ultrasound/radionucleotide uptake studies
serum Abs
low TSH and high T4
hyperthyroid
high TSH and low T4
hypothyroid
normal thyroid
euthyroid
ultrasound of thyroid
tells you cystic vs. solid
toxic
hyperfunctioning
elevated T3 and T4
thyrotoxicosis
-hypermetabolic state
majority of hyperthyroid
graves disease
diffuse hyperplasia of thyroid
also caused by multinodular goiter and thyroid adenoma
3 most common causes of thyrotoxicosis
graves disease**
multinodular goiter
thyroid adenoma
T4 vs. T3
T3 higher activity
T4 higher levels (10:1)
overactive sympathetics
with hyperthyroidism
increased metabolism, heat intolerance, weight loss with increased appeitite, tachycardia, palpitations, cardiomegaly, anxiety, insomnia
hyperthyroidism
early manifestations of hyperthyroidism
cardiac manifestations
tachy, palps, cardiomegaly
also atrial fib possible
complication - CHF
low output heart failure
thyrotoxic cardiomyopathy
reversible left ventricular dysfunction
individuals with hyperthyroidism
GI and hyperthyroid
hypermotility, diarrhea, malabsorption
lid lag
seen with hyperthyroid
-due to sympathetic overstiulation of mullers muscle (superior tarsal m)
proptosis
graves disease
protrusion of eyeballs
skeletal system and hyperthyroid
thyroid hormone - stimulates osteoporosis and increased fracture risk
sudden onset of severe hyperthyroid
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
women with hypothyroid
don’t overtreat - can lead to osteoporosis
teratoma
commonly has thyroid tissue as well**
exopthalmos
graves disease
rash on front of shins
pretibial myxedema
-seen in graves disease
most common cause of endogenous hyperthyroid
graves disease
graves disease
females age 20-40yo
autoantibodies for TSH receptor - TSI
TSI
thyroid stimulating immunoglobulin
antibody present in graves disease** 90% of patients
symmetrical enlargement of thyroid
graves disease
diffuse hypertrophy and hyperplasia
diffuse enlargement of thyroid**
diffuse enlargement of thyroid
graves disease
- also increased blood supply
- may hear bruit
beefy red thyroid, heat intolerance, palpitations, enlarged thyroid, bruit
graves disease
exopthalmos with graves
inflammatory process causes this - glycosaminoglycan and lymphoid infiltrate deposition**
tx will move eyeballs back
if bad - corneal abrasions bc can’t close eyelids
sympathetic overactivity
wide, staring gaze and lid lag
pretibial myxedema
seen in graves disease
basis of this localization is not clear
only in minority of patients
diagnosis of graves disease
elevated T4 and T3
depressed TSH levels
radioiodine scan - diffuse increased uptake of iodine
prognosis of graves disease
tx - beta-blockers for sympathetic sx
also to decrease thyroid hormone synthesis - thionamides, radioiodine ablation, thyroidectomy
surgery in graves
if large goiter compressing surrounding structure
42yo F weight gain, constipation, feels cold, thyroid symmetric and diffusely enlarged, TSH increased, T4 decreased
hypothyroid
decreased uptake on radionucleotide study
anti-TPO antibodies
hypothyroid
-hashimotos
common cause of hypothyroid
hashimotos
autoimmune destruction of thyroid
anti-TPO Abs
weight loss
graves
weight gain
hashimotos
graves vs. hashimotos
chronic inflammation in hashimotos
overstimulation in graves
pregnant women
hard to diagnose thyroid function
congenital hypothyroidism
worldwide
endemic iodine deficiency
autoimmune hypothyroidism
most common in iodine sufficient areas of world
live in mountains
goiter belt - central or south america
eat green veggies, live in himalayas, diffuse enlargement of neck
hypothyroid**
hypothyroid in childhood
cretinism
severe mental retardation, short stature, coarse facial features, protruding tongue, umbilical hernia
hypothyroid
maternal T3 and T4 cross placenta - critical for fetal brain development
myxedema
hypothyroidism in older child or adult
slowing of physical and mental activity
listless, cold intolerant, overweight
constipation, decreased sweating (decreased sympathetics)
atherogenic profile
with hypothyroidism
increased in total cholesterol and LDL levels
increased cardiovascular problems
nonpitting edema, broad coarse facial features, enlarged tongue, deep voice
hypothyroid
thyroiditis
inflammation of thyroid gland
fibrous thyroiditis
reidel
subtypes of thyroiditis
hashimoto - most common
granuloma (de quervain)
subacute lymphocytic thyroiditis
needle aspiration of thyroid with lots of lymphocytes
hashimotos
-inflammatory process
hurthle cells
in hashimoto thyroiditis
thyroid follicle atrophy lined with epithelial cells with abundant eosinophilic granular cytoplasm
painless enlargement of thyroid, symmetric and diffuse enlargement
hashimotos
transient thyrotoxicosis
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
increased risk of developing other autoimmune disease
hashimotos
both endocrine and nonendocrine
increased risk for development of marginal zone B cell lymphomas in thyroid
with hashimotos disease
subacute lymphocytic thyroiditis
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
granulomatous thyroiditis
de quervains
women age 40-50yo
triggered by viral infection
-history of upper respiratory infection
multinucleated giant cells
upper respiratory infection followed by thyroiditis
granulomatous thyroiditis
painful thyroid
granulomatous thyroiditis
fibrosis involving thyroid
reidel thyroiditis
rare disorder
associated with fibrosis of retroperitoneum
-manifestation of IgG4 autoimmune disease