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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
Q

Radioactive iodine uptake is increased and radioiodine scans show a diffuse uptake of iodine throughout the thyroid gland

A

Graves Disease

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26
Q

triad:
Diffuse hyperplasia of the thyroid gland
Ophthalmopathy with exophthalmos
Dermopathy with pretibial changes

A

Graves Disease

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27
Q

exopthalmos and proptosis

A

Graves Disease

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28
Q

diffuse papillary hyperplasia
scalloped colloid

A

Graves Disease

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29
Q

Enlargement of the thyroid gland
Most common manifestation of thyroid disease

A

diffuse and multinodular goiter

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30
Q

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

A

goiter

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31
Q

Mass effect of the enlarged thyroid gland- can reach up to 2000 grams (normal weight of thyroid gland is 30g)

A

goiter

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32
Q

May become hyperthyroid if have an autonomously functioning adenomatoid thyroid nodule- toxic multinodular goiter

A

Plummer Syndrome

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33
Q
A

diffuse and multinodular goiter

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34
Q

papillary hyperplasia w/out scalloped colloid

A

diffuse and multinodular goiter

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35
Q

distension of follicle w/ colloid and papillary hyperplasia (on histology it is not diffuse)

A

diffuse and multinodular goiter

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36
Q

post-partum necrosis of pituitary gland can sometimes present b/c of hypothyroidism

A

Sheehan Syndrome

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37
Q

Any condition that interferes with the production of thyroid hormone

A

hypothyroidism

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38
Q

results from an intrinsic abnormality of the thyroid gland

A

primary hypothyroidism

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39
Q

usually results from hypothalamic or pituitary disease
Pituitary tumor, post partum necrosis, trauma

A

secondary hypothyroidism

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40
Q

worldwide main cause of hypothyroidism

A

iodine deficiency

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41
Q

most common cause of hypothyroidism in developed nations

A

Hashimoto’s thyroiditis

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42
Q

hypothyroidism that can be due to surgical or radiation ablation

A

Iatrogenic hypothyroidism

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43
Q

hypothyroidism that develops during infancy or early childhood; causes mental decline and short stature

A

Cretinism

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44
Q

hypothyroidism in older children and adults; presents with mental decline, cold intolerance, constipation, heart failure

A

Myxedema

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45
Q
A

cretinism

46
Q
A

cretinism

47
Q

______ hormones essential to fetal brain development including T3 and T4 cross the placenta

A

maternal

48
Q

If ______ thyroid deficiency is present before development of the fetal thyroid gland, mental retardation is severe

A

maternal

49
Q

_________ablation is contraindicated for treatment of hyperthyroidism during pregnancy as it can cross the placenta and destroy the fetal thyroid gland resulting in cretinism

A

radioactive iodine

50
Q

Accumulation of mucopolysaccharides in skin and other tissues; Total opposite of thyrotoxicosis

A

Myxedema

51
Q

mimic depression, mental apathy, sluggishness

A

Myxedema

52
Q

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

A

Myxedema

53
Q

get an accumulation of this substance in the pretibial areas which results in the pretibial _______

A

myxedema

54
Q
A

myxedema

55
Q

to diagnose hypothyroidism

A

serum TSH (increased)
free T4 (decreased)

56
Q

Most common cause of hypothyroidism in areas where iodine is sufficient (in developed countries); Gradual thyroid failure secondary to autoimmune destruction of the gland

A

chronic lymphocytic thyroiditis Hashimoto’s

57
Q

normally seen in female patients 45-65 yrs; Gradual thyroid failure secondary to autoimmune destruction of the gland

A

chronic lymphocytic thyroiditis Hashimoto’s

58
Q

Circulating antithyroid autoantibodies followed by antibody dependent cell mediated cytotoxicity

A

Chronic lymphocytic thyroiditis Hashimoto’s

59
Q

aka Struma lymphomatosa

A

chronic lymphocytic thyroiditis hashimoto’s

60
Q

_______is a replacement of the thyroid parenchyma by inflammatory cells and fibrosis

A

Hashimoto’s Thyroiditis

61
Q

Not just autoantibodies but cytotoxic mediated cell death

A

Hashimoto’s Thyroiditis

62
Q

Painless enlargement of the thyroid gland in a middle aged woman with hypothyroidism

A

Hashimoto’s Thyroiditis

63
Q

Pts are at increase risk for development of B cell non-Hodgkin’s lymphoma

A

Hashimoto’s thyroiditis

64
Q

Microscopically- replacement of the thyroid gland by a lymphocytic infiltrate with germinal centers, Hurthle cell change to thyrocytes and areas of fibrosis

A

Hashimoto’s Thyroiditis

65
Q

cells get big and fat and pink (tons of eosinophils) not specific for hashimotos but is key for this too look for

A

Hurthle cell change in Hashimoto’s Thyroiditis

66
Q

Lymphoid hyperplasia with germinal centers and epithelial cells with Hurthle cell change

A

Hashimoto’s thyroiditis

67
Q

Dense inflammatory cell infiltrate with pronounced germinal centers; sometimes can get so many that is looks like a lymph node

A

Hashimoto’s thyroiditis

68
Q

lymphocytic infiltrate, germinal center and Hurthle epithelial cells (larger, lots of eosinophils in cytoplasm and nuclei get bigger)

A

Hashimoto’s thyroiditis

69
Q

Thyroiditis triggered by a viral infection; self-limited

A

Subacute Granulomatous (de Quervain’s) thyroiditis

70
Q

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

A

Subacute granulomatous (de Quervain’s) thyroiditis

71
Q

disruption of follicles with extravasation of colloid and a granulomatous reaction

A

Subacute granulomatous (de Quervain’s) thyroiditis

72
Q

Painless
Post-partum thyroiditis
Most likely autoimmune

A

Subacute lymphocytic thyroiditis

73
Q

Extensive fibrosis involving the thyroid gland with extension into the adjacent neck structures
(Woody thyroiditis)

A

Riedel’s thyroiditis

74
Q

extensive replacement of the thyroid gland by fibrous tissue

A

Reidel’s thyroiditis

75
Q

If you see younger patient and a male: think thyroid_____

A

neoplasm

76
Q

nodule in young male
hot nodules on radioactive iodine scan (benign)

A

thyroid neoplasms

77
Q

painless benign neoplasms derived from follicular epithelium (cold on scan)

A

thyroid adenomas

78
Q

_____ nodules are functional

A

hot

79
Q

_____ nodules are nonfunctional

A

cold

80
Q

important to note that adenomas and malignant nodules are usually what temperature on scan

A

cold

81
Q

Grossly, ______ are usually well circumscribed on cut section.

A

adenomas

82
Q

R
L

A

R: normal
L: follicular adenoma

83
Q

what kind of thyroid neoplasm

A

follicular

84
Q

most thyroid carcinomas are derived from ________

A

follicular epithelium

85
Q

main type of thyroid carcinoma

A

papillary

86
Q

second type of thyroid carcinoma derived from follicular epithelium

A

follicular

87
Q

_____carcinoma arises from the parafollicular C cells of the thyroid gland

A

medullary

88
Q

the most common endocrine malignancy in the US

A

thyroid carcinoma

89
Q

thyroid carcinoma that spreads through lymphathics and are nonfunctional; can have cervical lymph node metastasis

A

papillary thyroid carcinoma

90
Q

to diagnose:
Optically clear, ground glass, orphan Annie(glasses), overlapping nuclei

A

papillary carcinoma

91
Q

______concentric calcifications of necrotic tumor cells

A

psammoma bodies (seen in papillary carcinoma)

92
Q

Micro-optically clear nuclei with nuclear overlapping, Orphan Annie nuclei

A

papillary thyroid carcinoma

93
Q

where is this metastatic papillary thyroid carcinoma

A

lymph node

94
Q

about 50% of the time, patients with papillary carcinoma present w/ ______ lymph node mets

A

cervical lymph nodes

95
Q

______ seen in a papillary thyroid carcinoma

A

Psammoma bodies

96
Q

where else can you see psammoma bodies

A

serous tumors of ovary
mesothelioma

97
Q

cytology of papillary thyroid carcinoma w/ ________

A

psammoma bodies

98
Q

the presence of the _____mutation correlates with adverse prognostic factors like metastatic disease and extra thyroidal extension

A

BRAF

99
Q

mutations in __ and ___ seen with papillary carcinoma

A

RET
BRAF

100
Q

Patients are of older age than papillary carcinoma
Lymph node mets are not common; hematogenous spread more common

A

Follicular thyroid carcinoma

101
Q

mets in ____ and ___ with follicular thyroid carcinoma

A

brain mets and liver mets

102
Q

identifying capsular and vascular invasion

A

Follicular carcinoma

103
Q

vascular invasion

A

follicular carcinoma

104
Q

Neuroendocrine neoplasm derived from the parafollicular C-cells

A

medullary thyroid carcinoma

105
Q

______ thyroid carcinoma that secretes calcitonin (most of the time)

A

medullary

106
Q

70% sporadic; 30% familial w/ this carcinoma

A

medullary thyroid carcinoma

107
Q

_____ mutations seen in medullary thyroid carcinoma

A

RET

108
Q

All members of _____ kindreds which carry the RET mutations are offered prophylactic thyroidectomies (for medullary thyroid carcinoma in family)

A

MEN2

109
Q

Spindled cells which form nests and trabeculae; Amyloid stroma derived from altered calcitonin; Eosinophilic stroma; stain with congo red; Can stain for calcitonin

A

Medullary thyroid carcinoma

110
Q

Familial cases:
Occur in the setting of MEN 2A or 2B
Familial medullary carcinoma without an association with MEN syndrome

A

medullary thyroid carcinoma

111
Q

Both sporadic and familial medullary carcinomas demonstrate _____ mutations

A

RET

112
Q

amyloid stroma
no colloid
spindled cells

A

medullary thyroid carcinoma

ENR Biweekly 3 (14 decks)

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