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Endocrine- MHD > Thyroid > Flashcards

Thyroid Flashcards

1
Q

What are the two main cell types of the thyroid gland?

A

Follicular and parafollicular

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2
Q

What is the role of parafollicular cells?

A

Secretes calcitonin

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3
Q

How do thyroid hormones affect protein synthesis?

A

Stimulation of protein synthesis

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4
Q

How do thyroid hormones affect carbohydrates and lipids?

A

Increases carbohydrate and lipid catabolism

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5
Q

How do thyroid hormones affect the CNS?

A

They play a critical role in the development of the brain in fetuses and neonates

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6
Q

Differentiate hyperthyroidism from thyrotoxicosis

A

Thyrotoxicosis- elevated T4/T3 in the body (endogenous or exogenous, or struma ovarii)

Hyperthyroidism- hyperfunctioning of the thyroid gland

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7
Q

Describe the CNS/neuromuscular symptoms of hyperthyroidism

A

nervousness, emotional lability, insomnia, muscle weakness, fine tremor of the hands

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8
Q

What are the ocular symptoms of hyperthyroidism?

A

wide staring gaze and lid lag

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9
Q

What is the single more sensitive screening test for hyperthyroidism?

A

TSH measurement

Low in hyperthyroidism

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10
Q

Following a radioactive iodine uptake administration, what would the uptake pattern be in Graves disease, toxic adenoma, and thyroiditis?

A

Graves- diffuse uptake
Toxic adenoma- localized
Thyroiditis- reduced uptake

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11
Q

What is the most common cause of hypothyroidism in developing countries? In developed countries?

A

Developing countries: iodine deficiency

Developed countries: Hashimoto’s thyroiditis

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12
Q

What is the secondary cause of hypothyroidism?

A

Pituitary failure

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13
Q

What is hypothyroidism of children called? Adults?

A

Infants/early childhood- cretinism

Adults- myxedema

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14
Q

What are the sequelae of cretinism?

A

Depends on when the iodine deficiency occurred- if mom is also iodine deficient, it is worse

Mental retardation, short stature, coarse facial features

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15
Q

What are the characteristics of myxedema?

A

Gradual slowing of mental/physical function

Fatigue, lethargy, apathy, slowed speech…

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16
Q

What is the most sensitive screening test for hypothyroidism?

A

TSH levels (they will be increased)

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17
Q

Name two types of thyroiditis with pain

A

Infectious- usually bacterial, you don’t intervene

Subacute granulomatous De Quervain’s thyroiditis

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18
Q

List three types of painless thyroiditis

A

Subacute lymphocytic thyroiditis
Reidel’s thyroiditis
Hashimoto’s thyroiditis

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19
Q

What is the cause of Hashimoto’s thyroiditis?

A

Autoimmune destruction of thyroid gland –> failure and hypothyroidism

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20
Q

What are the three immunologic attacks against the thyroid?

A

CD8+ cytotoxic T cells
IFN-gamma/pro-inflammatory cytokine destruction
Anti-thyroid antibodies

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21
Q

What are the three autoimmune antibodies seen in Hashimotos?

A

TPO
TSH receptor
Iodine receptor

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22
Q

What is the characteristic cell seen in Hashimoto’s thyroiditis?

A

Hurthle cells/ oncocytes - loaded with mitochondria and therefore appear granular/very pink

23
Q

People with Hashimoto’s are at increased risk of developing what neoplasm?

A

Non-Hodgkins B cell lymphoma

24
Q

What is the etiology of De Quervain’s thyroiditis?

A

Viral or Post-viral inflammatory response-

Either viral antigens or infection induced T-cell activation leads to destruction of thyroid cells

25
Q

What is the prognosis of De Quervain’s thyroiditis?

A

Self-limited

26
Q

Is De Quervain’s thyroiditis painful or painless?

A

Painful

27
Q

What is the clinical course of De Quervain’s thyroiditis?

A

History of upper respiratory infection
Transient hyperthyroidism diminishing in 2-6 weeks
Recovery to normal function in 6-8 weeks

28
Q

What are the symptoms of Riedel’s thyroiditis?

A

Extensive fibrosis involving thyroid and contiguous neck structures (goes OUTSIDE the thyroid and squeezes those structures)

Hard and fixed masses mimic cancer

29
Q

What is the most common cause of endogenous hyperthyroidism?

A

Graves disease

30
Q

What is the triad of findings associated with Graves?

A
  1. Diffuse hyperfunctional enlargement of the thyroid
  2. Infiltrative ophthalmopathy –> exophthalmos
  3. Infiltrative dermopathy - pretibial myxedema
31
Q

What is the most common autoantibody seen in Graves disease?

A

Thyroid stimulating immunoglobulin (TSI)

-Bind the TSH receptor and mimics its action

32
Q

What differentiates the histology of papillary carcinoma of the thyroid from graves?

A

Graves: papillary structures with NO fibrovascular core, pale colloid with SCALLOPED margins

33
Q

What is a toxic vs nontoxic goiter?

A

Toxic: hyperfunctioning

Non-toxic: not hyperfunctioning

34
Q

What is the progression of a diffuse goiter?

A

They all become multinodular goiters

35
Q

Are the multinodular goiter thyroids usually hypothyroid, euthyroid or hyperthyroid

A

Euthyroid

36
Q

What is Plummer’s Syndrome?

A

Toxic multinodular goiter due to development of an autonomous nodule

37
Q

What is the most common thyroid cancer?

A

Papillary thyroid carcinoma

38
Q

Are nodules in young patients more likely to be benign or malignant?

A

Malignant

39
Q

What is the only benign tumor of the thyroid?

A

Follicular Adenoma

40
Q

What are two genes seen in both follicular adenomas and follicular carcinomas?

A

RAS and PAX-PPARgamma fusion gene

41
Q

How do we differentiate follicular adenomas from follicular adenocarcinomas?

A

Follicular adenomas are encompassed by a well-defined capsule (no infiltration)

42
Q

What is the treatment for a follicular adenoma?

A

Lobectomy

These have an excellent prognosis- no recurrence

43
Q

What is medullary carcinoma of the thyroid?

A

Neuroendocrine carcinoma of the parafollicular (C) cells

44
Q

What are the histologic features of papillary carcinoma of the thyroid?

A

Branching papillae with a fibrovascular core lined with multiple layers of cuboidal to columnar epithelium

+ Orphan annie-eyed nuclei and psammoma bodies

45
Q

Which variant of papillary carcinoma has a poor prognosis?

A

Tall cell variant

46
Q

Papillary carcinomas with which genetic marker correlates to a worse prognosis?

A

BRAF

47
Q

What is the most common genetic rearrangement seen in papillary thyroid canceR?

A

RET/PTC

48
Q

Follicular carcinoma of the thyroid must be separated into what type subsets, as their prognosis is very different.

A

Minimally invasive- great prognosis

Widely invasive- bad prognosis

49
Q

Which two hormones may be secreted in medullary carcinoma of the thyroid?

A

ACTH or calcitonin

50
Q

Medullary carcinoma of the thyroid is associated with which MEN syndrome?

A

MEN2A or MEN2B

51
Q

Amyloid deposition is seen in which thyroid carcinoma?

A

Medullary carcinoma

52
Q

Which thyroid cancer has the worst prognosis?

A

Anaplastic carcinoma- 100% death within a year

53
Q

What is a thyroglossal duct cyst and what’s the problem with it?

A

Incomplete atrophy of the thyroglossal duct cyst- presents at any age as a midline cyst or anterior mass

Risk of infection/abscess

Endocrine- MHD (17 decks)

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