Thursday - Thyroid path - Krafts Flashcards
T4 goes up a little, what happens to TSH
Goes down a lot.
or other way T4 down a little, TSH up a lot
T4 and TSH labs of primary hyperthyroidism
Secondary?
T4 high
TSH low
T4 high
TSH high
T4 and TSH labs of primary hyporthyroidism
Secondary?
problem is somewhere other than thyroid galnd
T4 low
TSH high
T4 low
TSH low
3 antibodies that could be in Hashimotos or Grave disease
anti-peroxidase - usually hashimotos's anti-thyroglobulin - either anti-TSH receptor - either, but in Graves, it stimulates
Systemic signs of hyperthyroidism
Weight loss, warm fast heart tremor diarrhea eyelid stays open when eyes move down
Most common cause of Hyperthyroid
others?
Graves disease
multinodular goiter
thyroid adenoma/carcinoma
pituitary adenoma
stroma ovarii
Systemic signs of hyporthyroidism
fatigue, weight gain slow heart delayed reflexes dry skin, hair loss no appetite deep voice Myxedema - under eyes mental changes
Congenital hypothyroidism is due to:
treatment:
genetic or iodine deficient
Thyroid hormone or iodine
Autoimmune thyroiditis called:
symptom:
Labs?
antibodies?
Hashimoto's painless, large thyroid low T4, high TSH anti-peroxidase anti-thyroglobulin
Pathophys of Hashimoto’s
T cells recognize thyroid as antigen –> stimulate b cells to make antibodies
De Quervain thyroiditis
symptoms
histo:
Big, SORE thyroid recent URI had hypERthyroid jaw pain it's self limiting
granulomas, lymphocytes
Histo findings of hashimoto’s
inflammation
large germinal centers
Hürthle cells - big, pink, inflamed cells
Histo finding of Silent thyroiditis
cause?
just lots of lymphycytes
don’t know, HLA, autoimmune?
Hypothyroid with a hard mass of fibrous tissue called?
Reidel thyroiditis
- painless
Triad of symptoms seen in Graves disease
Hyperthyroid
Opthalmopathy
Dermopathy
- thick skin/rash
Histo of graves disease
“busy”
scalloping of colloid
Antibodies in Graves disease
why eye and skin symptoms??
anti-TSH –> proliferation of follicles
thyroid hormone released –> hyper T3,4
TSH receptor is also in retro-orbital tissue and pre-tibial tissue
What is a goiter?
big thyroid for any reason
usually decreased T4 –> increased TSH
irritation or palpation of a goiter can cause what?
multinodular goiter
Thyroid nodule. awe, it’s cancer.
benign or malignant?
more likely cancer if…
Usually benign adenoma
solitary nodule, male, radiation
Biopsy a thyroid nodule. What do you see if you determine it just needs treatment, but not removed
Hürthle cells - hashimoto’s
if it’s just follicles, it could be cancer still
Caracteristics of thyroid adenoma
solitary, encapsulated, no invasion
gain of funtion
Why do you take out adenomas
they can look the same as follicular carcinoma
4 types of thyroid carcinoma
Papillary - 80%
Follicular - 10
medullary - 5
anaplastic - 5
Papillary Thyroid carcinoma.
Prognosis
Where can it metastasize
histo finding
good prognosis
local lymph node
obviously looks papillary
“orphan annie” nuclei - chromatin pushed to sides
psammoma bodies
Follicular Thyroid Carcinoma
prognosis
where does it metastasize
good, worse with age
lung and bone
Medullary Thyroid carcinoma, what cells?
prognosis
where does it metastasize
Histo?
C cells - make calcitonin
good if not metastisized
amyloid - bubble gum looking
Anaplastic Thyroid Carcinoma
prognosis
Real bad
it’s rare, grows quickly, usually metastasizes
