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Endo II > Pathology of the Thyroid I > Flashcards

Pathology of the Thyroid I Flashcards

1
Q

thyroid axis

A

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

T3 and T4 negative feedback on hypothalamus and anterior pituitary

TSH receptor - GPCR

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2
Q

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

A

hyperthyroidism

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3
Q

eye protrusion in graves

A

accumulation of loose CT behind eyeballs

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4
Q

thyroid function testing

A

serum TSH and T4
ultrasound/radionucleotide uptake studies
serum Abs

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5
Q

low TSH and high T4

A

hyperthyroid

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6
Q

high TSH and low T4

A

hypothyroid

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7
Q

normal thyroid

A

euthyroid

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8
Q

ultrasound of thyroid

A

tells you cystic vs. solid

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9
Q

toxic

A

hyperfunctioning

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10
Q

elevated T3 and T4

A

thyrotoxicosis

-hypermetabolic state

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11
Q

majority of hyperthyroid

A

graves disease

diffuse hyperplasia of thyroid

also caused by multinodular goiter and thyroid adenoma

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12
Q

3 most common causes of thyrotoxicosis

A

graves disease**
multinodular goiter
thyroid adenoma

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13
Q

T4 vs. T3

A

T3 higher activity

T4 higher levels (10:1)

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14
Q

overactive sympathetics

A

with hyperthyroidism

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15
Q

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

A

hyperthyroidism

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16
Q

early manifestations of hyperthyroidism

A

cardiac manifestations

tachy, palps, cardiomegaly

also atrial fib possible

complication - CHF

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17
Q

low output heart failure

A

thyrotoxic cardiomyopathy

reversible left ventricular dysfunction

individuals with hyperthyroidism

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18
Q

GI and hyperthyroid

A

hypermotility, diarrhea, malabsorption

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19
Q

lid lag

A

seen with hyperthyroid

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

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20
Q

proptosis

A

graves disease

protrusion of eyeballs

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21
Q

skeletal system and hyperthyroid

A

thyroid hormone - stimulates osteoporosis and increased fracture risk

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22
Q

sudden onset of severe hyperthyroid

A

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

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23
Q

women with hypothyroid

A

don’t overtreat - can lead to osteoporosis

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24
Q

teratoma

A

commonly has thyroid tissue as well**

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25
Q

exopthalmos

A

graves disease

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26
Q

rash on front of shins

A

pretibial myxedema

-seen in graves disease

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27
Q

most common cause of endogenous hyperthyroid

A

graves disease

28
Q

graves disease

A

females age 20-40yo

autoantibodies for TSH receptor - TSI

29
Q

TSI

A

thyroid stimulating immunoglobulin

antibody present in graves disease** 90% of patients

30
Q

symmetrical enlargement of thyroid

A

graves disease

diffuse hypertrophy and hyperplasia

diffuse enlargement of thyroid**

31
Q

diffuse enlargement of thyroid

A

graves disease

  • also increased blood supply
  • may hear bruit
32
Q

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

A

graves disease

33
Q

exopthalmos with graves

A

inflammatory process causes this - glycosaminoglycan and lymphoid infiltrate deposition**

tx will move eyeballs back

if bad - corneal abrasions bc can’t close eyelids

34
Q

sympathetic overactivity

A

wide, staring gaze and lid lag

35
Q

pretibial myxedema

A

seen in graves disease

basis of this localization is not clear

only in minority of patients

36
Q

diagnosis of graves disease

A

elevated T4 and T3
depressed TSH levels

radioiodine scan - diffuse increased uptake of iodine

37
Q

prognosis of graves disease

A

tx - beta-blockers for sympathetic sx

also to decrease thyroid hormone synthesis - thionamides, radioiodine ablation, thyroidectomy

38
Q

surgery in graves

A

if large goiter compressing surrounding structure

39
Q

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

A

hypothyroid

decreased uptake on radionucleotide study

40
Q

anti-TPO antibodies

A

hypothyroid

-hashimotos

41
Q

common cause of hypothyroid

A

hashimotos

autoimmune destruction of thyroid

anti-TPO Abs

42
Q

weight loss

A

graves

43
Q

weight gain

A

hashimotos

44
Q

graves vs. hashimotos

A

chronic inflammation in hashimotos

overstimulation in graves

45
Q

pregnant women

A

hard to diagnose thyroid function

46
Q

congenital hypothyroidism

A

worldwide

endemic iodine deficiency

47
Q

autoimmune hypothyroidism

A

most common in iodine sufficient areas of world

48
Q

live in mountains

A

goiter belt - central or south america

eat green veggies, live in himalayas, diffuse enlargement of neck

hypothyroid**

49
Q

hypothyroid in childhood

A

cretinism

50
Q

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

A

hypothyroid

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

51
Q

myxedema

A

hypothyroidism in older child or adult

slowing of physical and mental activity

listless, cold intolerant, overweight

constipation, decreased sweating (decreased sympathetics)

52
Q

atherogenic profile

A

with hypothyroidism

increased in total cholesterol and LDL levels

increased cardiovascular problems

53
Q

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

A

hypothyroid

54
Q

thyroiditis

A

inflammation of thyroid gland

55
Q

fibrous thyroiditis

A

reidel

56
Q

subtypes of thyroiditis

A

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

57
Q

needle aspiration of thyroid with lots of lymphocytes

A

hashimotos

-inflammatory process

58
Q

hurthle cells

A

in hashimoto thyroiditis

thyroid follicle atrophy lined with epithelial cells with abundant eosinophilic granular cytoplasm

59
Q

painless enlargement of thyroid, symmetric and diffuse enlargement

A

hashimotos

60
Q

transient thyrotoxicosis

A

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

61
Q

increased risk of developing other autoimmune disease

A

hashimotos

both endocrine and nonendocrine

62
Q

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

A

with hashimotos disease

63
Q

subacute lymphocytic thyroiditis

A

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

64
Q

granulomatous thyroiditis

A

de quervains

women age 40-50yo

triggered by viral infection
-history of upper respiratory infection

multinucleated giant cells

65
Q

upper respiratory infection followed by thyroiditis

A

granulomatous thyroiditis

66
Q

painful thyroid

A

granulomatous thyroiditis

67
Q

fibrosis involving thyroid

A

reidel thyroiditis

rare disorder

associated with fibrosis of retroperitoneum
-manifestation of IgG4 autoimmune disease

Endo II (12 decks)

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