Pathology of the Thyroid II Flashcards
(53 cards)
goiter
enlargement of thyroid
impaired synthesis of thyroid hormon
most often - dietary iodine deficiency
diffuse nontoxic goiter
simple**
enlargement of entire gland without nodularity
endemic goiter
areas with low iodine
can lead to diffuse nontoxic simple goiter
sporadic goiter
less frequent than endemic
-more in female around puberty or young adult life
increased TSH levels
lead to hypertrophy and hyperplasia of thyroid follicular cells
with simple goiter
phases of nontoxic goiter formation
hyperplastic phase
-diffuse and symmetric enlargement
colloid involution
-if increased dietary iodine or demand for thyroid hormone decreases - stimulated follicular epithelium involutes - resulting in enlarged colloid rich gland
simple goiter clinical
typically euthyroid
clinical problems - mass effects
normal T3 and T4 with elevated TSH
multinodular goiter
over time - recurrent episodes of hyperplasia and involution
irregular enlargement of thyroid
often mistaken for neoplasms
female with tickle in throat, solid lesion near thyroid
multinodular goiter
but need to see if is neoplasm
male - more likely to be noeplastic
plunging goiter
multinodular goiter growing behind sternum and clavicles
multinodular goiter morph
asymmetrically enalrged
colloid rich follicles lined by flattened inactive epithelium and areas of follicular hyperplasia
follicular neoplasm of thyroid
prominent capsule between hyperplastic nodule and residual compressed thyroid parenchyma
multinodular goiter clinical
often see mass effects
airway obstruction, dysphagia, superior vena cava syndrome**
most patients euthyroid
small number of patients - toxic multinodular goiter (hyperthyroidism)
plummer syndrome
toxic multinodular goiter
has NO dermopathy or ophthalmopathy - as in graves
uneven iodine uptake
solitary thyroid nodule
dominant nodule in multinodular goiter
can mimic a thyroid noeplasm
solitary thyroid nodule
more common in women
majority are localized and non-neoplastic
benign neoplasms outnumber thyroid carcinomas 10:1
clinical criteria for thyroid nodule
solitary - more likely neoplastic
younger patient - more likely neoplastic
males - more likely neoplastic
radiation history - more likely thyroid malignancy
functional - take up radioiodine - hot nodule - tend to be benign
52yo M, lump in neck, solitary thyroid nodule, TSH and T4 normal
cold nodule radioiodine
fusion scan shows vascularity
male, solitary, cold nodule - worried about neoplasm
fusion scan
shows vasculature
follicular adenoma
adenoma of thyroid
discrete solitary mass derived from epithelium
toxic adenoma
produce thyroid hormone
independent of TSH stimulation
solitary spherical lesion in thyroid with capsule
thyroid adenoma
multinodular goiter - no capsule
follicular adenoma vs. carcinoma
evaluation for invasion of capsule is critical**
hurthle cell change
implies aggressiveness
