SFP: thyroid pathology I

Question 1

What nerve can be damaged in thyroid surgery?

Answer 1

Recurrent laryngeal nerve

Question 2

What hormone is most sensitive in diagnosing thyroid disease?

Answer 2

TSH

Question 3

Patient has low T4 and high TSH. What is this?

Answer 3

Primary hypothyroidism

Question 4

Patient has high T4 and low TSH. What is this?

Answer 4

Primary hyperthyroidism

Question 5

Patient has high T4 and high TSH. What could this be?

Answer 5

Pituitary TSH adenoma

Question 6

Patient has low T4 and low TSH. What could this be?

Answer 6

Hypopituitarism

Question 7

What is thyrotoxicosis?

Answer 7

Too much thyroid hormone; increased circulating T3 and T4. It may or may not be from hyperthyroidism.

Question 8

What is the most common cause of hyperthyroidism?

Answer 8

Grave’s disease

Question 9

What are clinical signs of excess thyroid hormone?

Answer 9

Anxiety, staring eyes, weight loss, heat intolerance, tachycardia, etc.

Question 10

What are clinical signs of low thyroid hormone?

Answer 10

Cold intolerance, fatigue, constipation, weight gain, coarse skin, periorbital edema

Question 11

What is the most common cause of hypothyroidism?

Answer 11

Iatrogenic (post-op) followed by Hashimoto’s

Question 12

What is cretinism?

Answer 12

Hypothyroidism developing in infancy or early childhood, often in areas with low iodine.

Question 13

What is the clinical presentation of cretinism?

Answer 13

Mental delay, coarse features, protruding tongue, short stature

Question 14

What may cause cretinism?

Answer 14

Sporadic issue from inborn error of metabolism, hypothyroidism in mom, improper iodine in mom.

Question 15

What is Hashimoto thyroiditis?

Answer 15

Thyroid failure due to autoimmune destruction of the gland.

Question 16

What may happen initially in Hashimoto thyroiditis?

Answer 16

Transient thyrotoxicosis from stores hormone releasing.

Question 17

What happens to the gland in Hashimoto’s?

Answer 17

Painless enlargement

Question 18

Polymorphisms with which antigen is associated with Hashimoto’s?

Answer 18

CTLA-4

Question 19

What antibodies are seen in Hashimoto’s?

Answer 19

Antithyroid peroxidase and antithyroglobulin

Question 20

What is the gross pathology of Hashimoto’s?

Answer 20

Enlarged, nodular, fleshy thyroid

Question 21

What is the histology of Hashimoto’s?

Answer 21

Extensive lymphocytic and plasma cell infiltrate, germinal centers, Hurthle cell change.

Question 22

What is hurthle cell change?

Answer 22

Metaplastic epithelial cells with granular eosinophilic cytoplasm. Seen in Hashimoto’s disease.

Question 23

What does Hashimoto’s disease increase risk for?

Answer 23

Non-Hodgkin lymphomas

Question 24

What is subacute granulomatous thyroiditis?

Answer 24

A painful thyroiditis characterized by granulomatous inflammation during viral infection or after viral infection.

Question 25

What is the gross pathology of subacute granulomatous thyroiditis?

Answer 25

Enlarged, firm thyroid. May look like malignancy.

Question 26

What is the histology of subacute granulomatous thyroiditis?

Answer 26

Giant cells/granulomas!!

Question 27

What is the clinical course of subacute granulomatous thyroiditis?

Answer 27

Initial transient thyrotoxicosis from stored hormone spilling out following damage that may be followed by transient hypothyroidism as the thyroid recovers. Should be fine in a few weeks.

Question 28

What is subacute lymphocytic thyroiditis?

Answer 28

Almost a precursor to Hashimoto’s; often occurs post-partum.

Question 29

What is Riedel thyroiditis?

Answer 29

A form of idiopathic fibrosis.

Question 30

What is palpation thyroiditis?

Answer 30

Iatrogenic from doing a thyroid exam causing hormone to spill out.

Question 31

What is grave’s disease?

Answer 31

Autoimmune hyperthyroidism.

Question 32

What is the clinical triad of grave’s disease?

Answer 32

1. Hyperthyroidism due to diffuse enlargement of the gland 2. Protruding eyes 3. Localized infiltrative dermopathy (pretibial myxedema)

Question 33

What genetic factors are associated with grave’s disease?

Answer 33

HLA associations and CTLA-4

Question 34

What are the autoantibodies involved in grave’s disease?

Answer 34

1. Thyroid stimulation immunoglobulin (mimics TSH) 2. TSH binding inhibitor immunoglobulin (inhibits thyroid function) 3. Thyroid growth stimulating immunoglobulin (proliferates epithelium)

Question 35

What is infiltrative ophthalmopathy?

Answer 35

T-cell mediated phenomenon in which TSH receptors in orbital preadipocytes become attack targets; seen in grave’s disease.

Question 36

What is the histology of grave’s disease?

Answer 36

Papillary hyperplasia with infoldings and scalloping of colloid.