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ENR Biweekly 3 > Roveda- Pathology of Thyroid Gland > Flashcards

Roveda- Pathology of Thyroid Gland Flashcards

1
Q

hypermetabolic state due to elevated levels of circulating free T3 and T4

A

Thyrotoxicosis

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2
Q

Overall revved up hypermetabolic state

A

hyperthyroidism

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3
Q

Cardiac manifestations is what brings people to clinical attention b/c being evaluated for tachycardia and palpitations

A

hyperthyroidism

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4
Q

Sometimes will see ocular manifestations first: wide eye gaze w/ lid lag

A

hyperthyroidism

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5
Q

abrupt onset of severe hyperthyroidism

A

thyroid storm

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6
Q

Assoc with Graves Disease- acute elevation in catecholamines

A

thyroid storm

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7
Q

can be a medical emergency if pt presents with cardiac arrhythmias

A

thyroid storm

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8
Q

thyrotoxicosis in the elderly- In these cases the diagnosis is usually made during lab evaluation for unexplained weight loss or worsening cardiovascular status

A

apathetic hyperthyroidism

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9
Q

most useful single screening test for hyperthyroidism

A

serum TSH

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10
Q

TSH levels are decreased even in the subclinical states in primary ____
Usually will also see increased levels of free T4

A

hyperthyroidism

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11
Q

example of In secondary hyperthyroidism—related to pituitary or hypothalamic disease (pituitary adenoma)—TSH levels may be normal or only slightly raised

A

TSH secreting adenoma

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12
Q

____ uptake helps confirm diagnosis of thyrotoxicosis

A

radioactive iodine uptake

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13
Q

diffuse uptake of radioactive iodine in the thyroid

A

Graves Disease

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14
Q

functioning adenoma of thyroid gland that w/ uptake of radioactive iodine will cause solitary nodule

A

toxic adenoma

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15
Q

decreased uptake of radioactive iodine seen with this

A

thyroiditis

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16
Q

Most common cause of endogenous hyperthyroidism

A

Graves Disease

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17
Q

diffusely enlarged hyperfunctioning thyroid gland
infiltrative ophthalmopathy
infiltrative dermoopathy

A

thyrotoxicosis in Graves Disease

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18
Q

cause of hyperthyroidism seen most commonly in female patients in their 20s-40s

A

Graves Disease

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19
Q

_____ disease is genetically susceptible and there is a high rate of concordance in monozygotic twins

A

Graves Disease

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20
Q

Most have thyroid stimulating immunoglobulins; but sometimes it is TSH binding inhibitor immunoglobulins

Can show manifestation of different autoantibodies

A

Graves Disease

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21
Q

Multiple autoantibodies to the TSH receptor
Thyroid stimulating immunoglobulin-binds to the TSH receptor and mimics the action of TSH

A

Graves Disease

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22
Q

T cell mediated autoimmune phenomena (hypersensitivity type II) being antibody mediated

A

Graves Disease

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23
Q

influx of lymphocytes
swelling and edema in extraocular muscles
increase in adipocytes

A

Graves Disease

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24
Q

Decrease TSH levels with elevated free T3 and T4
and clinically present w/ signs of thyrotoxicosis

A

Graves Disease

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25
Radioactive iodine uptake is increased and radioiodine scans show a diffuse uptake of iodine throughout the thyroid gland
Graves Disease
26
triad: Diffuse hyperplasia of the thyroid gland Ophthalmopathy with exophthalmos Dermopathy with pretibial changes
Graves Disease
27
exopthalmos and proptosis
Graves Disease
28
diffuse papillary hyperplasia scalloped colloid
Graves Disease
29
Enlargement of the thyroid gland Most common manifestation of thyroid disease
diffuse and multinodular goiter
30
When ______ develops as a result of iodine deficiency, there is impaired synthesis of the thyroid hormone. Therefore, there is usually an elevation of TSH which then causes an increase in the mass of the gland
goiter
31
Mass effect of the enlarged thyroid gland- can reach up to 2000 grams (normal weight of thyroid gland is 30g)
goiter
32
May become hyperthyroid if have an autonomously functioning adenomatoid thyroid nodule- toxic multinodular goiter
Plummer Syndrome
33
diffuse and multinodular goiter
34
papillary hyperplasia w/out scalloped colloid
diffuse and multinodular goiter
35
distension of follicle w/ colloid and papillary hyperplasia (on histology it is not diffuse)
diffuse and multinodular goiter
36
post-partum necrosis of pituitary gland can sometimes present b/c of hypothyroidism
Sheehan Syndrome
37
Any condition that interferes with the production of thyroid hormone
hypothyroidism
38
results from an intrinsic abnormality of the thyroid gland
primary hypothyroidism
39
usually results from hypothalamic or pituitary disease Pituitary tumor, post partum necrosis, trauma
secondary hypothyroidism
40
worldwide main cause of hypothyroidism
iodine deficiency
41
most common cause of hypothyroidism in developed nations
Hashimoto's thyroiditis
42
hypothyroidism that can be due to surgical or radiation ablation
Iatrogenic hypothyroidism
43
hypothyroidism that develops during infancy or early childhood; causes mental decline and short stature
Cretinism
44
hypothyroidism in older children and adults; presents with mental decline, cold intolerance, constipation, heart failure
Myxedema
45
cretinism
46
cretinism
47
______ hormones essential to fetal brain development including T3 and T4 cross the placenta
maternal
48
If ______ thyroid deficiency is present before development of the fetal thyroid gland, mental retardation is severe
maternal
49
_________ablation is contraindicated for treatment of hyperthyroidism during pregnancy as it can cross the placenta and destroy the fetal thyroid gland resulting in cretinism
radioactive iodine
50
Accumulation of mucopolysaccharides in skin and other tissues; Total opposite of thyrotoxicosis
Myxedema
51
mimic depression, mental apathy, sluggishness
Myxedema
52
Accumulation of mucopolysaccharide rich fluid in the skin and subcutaneous tissue leads to coarsening of the facial features, enlargement of the tongue and deepening of the voice
Myxedema
53
get an accumulation of this substance in the pretibial areas which results in the pretibial _______
myxedema
54
myxedema
55
to diagnose hypothyroidism
serum TSH (increased) free T4 (decreased)
56
Most common cause of hypothyroidism in areas where iodine is sufficient (in developed countries); Gradual thyroid failure secondary to autoimmune destruction of the gland
chronic lymphocytic thyroiditis Hashimoto's
57
normally seen in female patients 45-65 yrs; Gradual thyroid failure secondary to autoimmune destruction of the gland
chronic lymphocytic thyroiditis Hashimoto's
58
Circulating antithyroid autoantibodies followed by antibody dependent cell mediated cytotoxicity
Chronic lymphocytic thyroiditis Hashimoto's
59
aka Struma lymphomatosa
chronic lymphocytic thyroiditis hashimoto's
60
_______is a replacement of the thyroid parenchyma by inflammatory cells and fibrosis
Hashimoto's Thyroiditis
61
Not just autoantibodies but cytotoxic mediated cell death
Hashimoto's Thyroiditis
62
Painless enlargement of the thyroid gland in a middle aged woman with hypothyroidism
Hashimoto's Thyroiditis
63
Pts are at increase risk for development of B cell non-Hodgkin’s lymphoma
Hashimoto's thyroiditis
64
Microscopically- replacement of the thyroid gland by a lymphocytic infiltrate with germinal centers, Hurthle cell change to thyrocytes and areas of fibrosis
Hashimoto's Thyroiditis
65
cells get big and fat and pink (tons of eosinophils) not specific for hashimotos but is key for this too look for
Hurthle cell change in Hashimoto's Thyroiditis
66
Lymphoid hyperplasia with germinal centers and epithelial cells with Hurthle cell change
Hashimoto's thyroiditis
67
Dense inflammatory cell infiltrate with pronounced germinal centers; sometimes can get so many that is looks like a lymph node
Hashimoto's thyroiditis
68
lymphocytic infiltrate, germinal center and Hurthle epithelial cells (larger, lots of eosinophils in cytoplasm and nuclei get bigger)
Hashimoto's thyroiditis
69
Thyroiditis triggered by a viral infection; self-limited
Subacute Granulomatous (de Quervain's) thyroiditis
70
Seen in female patients 30-50 years of age; Onset is somewhat acute with pain in the neck assoc with fever, malaise, and variable enlargement of the gland
Subacute granulomatous (de Quervain's) thyroiditis
71
disruption of follicles with extravasation of colloid and a granulomatous reaction
Subacute granulomatous (de Quervain's) thyroiditis
72
Painless Post-partum thyroiditis Most likely autoimmune
Subacute lymphocytic thyroiditis
73
Extensive fibrosis involving the thyroid gland with extension into the adjacent neck structures (Woody thyroiditis)
Riedel's thyroiditis
74
extensive replacement of the thyroid gland by fibrous tissue
Reidel's thyroiditis
75
If you see younger patient and a male: think thyroid_____
neoplasm
76
nodule in young male hot nodules on radioactive iodine scan (benign)
thyroid neoplasms
77
painless benign neoplasms derived from follicular epithelium (cold on scan)
thyroid adenomas
78
_____ nodules are functional
hot
79
_____ nodules are nonfunctional
cold
80
important to note that adenomas and malignant nodules are usually what temperature on scan
cold
81
Grossly, ______ are usually well circumscribed on cut section.
adenomas
82
R L
R: normal L: follicular adenoma
83
what kind of thyroid neoplasm
follicular
84
most thyroid carcinomas are derived from ________
follicular epithelium
85
main type of thyroid carcinoma
papillary
86
second type of thyroid carcinoma derived from follicular epithelium
follicular
87
_____carcinoma arises from the parafollicular C cells of the thyroid gland
medullary
88
the most common endocrine malignancy in the US
thyroid carcinoma
89
thyroid carcinoma that spreads through lymphathics and are nonfunctional; can have cervical lymph node metastasis
papillary thyroid carcinoma
90
to diagnose: Optically clear, ground glass, orphan Annie(glasses), overlapping nuclei
papillary carcinoma
91
______concentric calcifications of necrotic tumor cells
psammoma bodies (seen in papillary carcinoma)
92
Micro-optically clear nuclei with nuclear overlapping, Orphan Annie nuclei
papillary thyroid carcinoma
93
where is this metastatic papillary thyroid carcinoma
lymph node
94
about 50% of the time, patients with papillary carcinoma present w/ ______ lymph node mets
cervical lymph nodes
95
______ seen in a papillary thyroid carcinoma
Psammoma bodies
96
where else can you see psammoma bodies
serous tumors of ovary mesothelioma
97
cytology of papillary thyroid carcinoma w/ ________
psammoma bodies
98
the presence of the _____mutation correlates with adverse prognostic factors like metastatic disease and extra thyroidal extension
BRAF
99
mutations in __ and ___ seen with papillary carcinoma
RET BRAF
100
Patients are of older age than papillary carcinoma Lymph node mets are not common; hematogenous spread more common
Follicular thyroid carcinoma
101
mets in ____ and ___ with follicular thyroid carcinoma
brain mets and liver mets
102
identifying capsular and vascular invasion
Follicular carcinoma
103
vascular invasion
follicular carcinoma
104
Neuroendocrine neoplasm derived from the parafollicular C-cells
medullary thyroid carcinoma
105
______ thyroid carcinoma that secretes calcitonin (most of the time)
medullary
106
70% sporadic; 30% familial w/ this carcinoma
medullary thyroid carcinoma
107
_____ mutations seen in medullary thyroid carcinoma
RET
108
All members of _____ kindreds which carry the RET mutations are offered prophylactic thyroidectomies (for medullary thyroid carcinoma in family)
MEN2
109
Spindled cells which form nests and trabeculae; Amyloid stroma derived from altered calcitonin; Eosinophilic stroma; stain with congo red; Can stain for calcitonin
Medullary thyroid carcinoma
110
Familial cases: Occur in the setting of MEN 2A or 2B Familial medullary carcinoma without an association with MEN syndrome
medullary thyroid carcinoma
111
Both sporadic and familial medullary carcinomas demonstrate _____ mutations
RET
112
amyloid stroma no colloid spindled cells
medullary thyroid carcinoma

ENR Biweekly 3 (14 decks)

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