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ENRP Exam 2 > Thyroid > Flashcards

Thyroid Flashcards

1
Q

essential action of the thyroid

A

increase basal metabolic rate

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2
Q

TSH stimulates the production of…

A

Thyroglobulin (TG)

*iodide is incorporated with TG before being cleaved into T3 and T4

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3
Q

causes of primary hyperthyroidism

A 
*most common*
diffuse hyperplasia (Graves)
hyperfunctioning multinodular goiter 
hyperfunctioning thyroid adenoma
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4
Q

cause of secondary hyperthyroidism

A

pituitary adenoma

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5
Q

primary vs secondary hyperthyroidism

A

elevated T3/T4 + low TSH = primary

elevated T3/T4 + high TSH = secondary

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6
Q

clinical presentation of apathetic hyperthyroidism

A

older adults with masked symptomatology

unexplained weight loss
CV disease

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7
Q

clinical presentation of classic hyperthyroidism

A 
perspiration
facial flushing
restlessness
exophthalmos
palpitations/tachy
diarrhea
weight loss
heat intolerance
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8
Q

thyroid storm

A 
hyperthyroid crisis:
fever
tachy
CHF
diarrhea
jaundice
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9
Q

thyroid storm causes

A

pregnancy/postpartum
hemithyroidectomy
drugs (amiodarone)

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10
Q

thyroid storm tx

A

treat manifestations:
beta blockers

treat underlying disease:
high dose iodide
thionamide
radioiodine ablation
surgery
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11
Q

most common etiology of hyperthyroidism

A

graves disease

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12
Q

classic diagnostic triad of graves disease

A

autoimmune hyperthyroidism with gland enlargement
infiltrative ophthalmology
pretibial myxedema

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13
Q

pathogenesis of graves disease affecting the orbit

A
  1. lymphocytes invade preorbital space
  2. fibroblasts have TSH receptor
  3. EOM swelling
  4. matrix accumulates
  5. adipocytes expand
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14
Q

Graves lab results

A

high T3/T4
low TSH
high TSI (thyroid stimulating Ig)

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15
Q

causes of primary hypothyroidism

A

Hashimoto thyroiditis
granulomatous thyroiditis
subacute lymphocytic thyroiditis
reidel thyroiditis

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16
Q

causes of secondary hypothyroidism

A

pituitary failure

hypothalamic failure

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17
Q

presentation of congenital hypothyroidism/cretinism

A

mental retardation
growth retardation
coarse facial features
umbilical hernias

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18
Q

etiology of congenital hypothyroidism

A

iodine deficiency of mother in pregnancy (endemic)
or
genetic alterations in thyroid metabolic pathways

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19
Q

clinical presentation of hypothyroidism/myxedema

A 
mental/physical sluggishness
weight gain
cold intolerance
low cardiac output
hypercholesterolemia
dry, brittle hair and nails
diastolic HTN
follicular keratosis
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20
Q

hashimoto thyroiditis

A

autoimmune hypothyroidism: auto-Ab against thyroglobulin and thyroid peroxidase

most common cause of hypothyroidism in iodide-sufficient areas

21
Q

progression of Hashimoto

A
  1. immune-mediated insult
  2. hyperactivity and enlargement
  3. follicular cell exhaustion
22
Q

clinical presentation of hashimoto

A

hypothyroid sx

exception: hashitoxicosis (early disease)

23
Q

histo of hashimoto

A

lymphocytic infiltrate with germinal centers

Hurthle cell metaplasia: atrophic follicle cells with eosinophilic change

24
Q

hashimoto Abs

A

hTg-Ab

hTPO-Ab

25
Q

graves Abs

A

primarily TSHR-Ab (TSI)
but
hTg-Ab and hTPO-Ab can also be present

26
Q

subacute lymphocytic thyroiditis

A

autoimmune!!

transient period of thyroid hormone irregularities that presents as hypo- or hyper-thyroid with goiter

can progress to permanent hypothyroidism

ex: postpartum thyroiditis

27
Q

granulomatous thyroiditis

A

aka de Quervains

painful granulomatous response to viral infection

hypo- or hyperthyroid

28
Q

Riedel thyroiditis

A

fibrosing thyroid process that extends into adjacent tissue

presents as euthyroid

*IgG4-related disease

29
Q

histo of Riedel thyroiditis

A

fibrosis
lymphocytes
plasma cells

30
Q

subacute lymphocytic Abs

A

TPO Abs

31
Q

goiter

A

thyroid enlargement

diffuse vs nodular
nontoxic vs toxic
benign vs malignant

32
Q

diffuse nontoxic goiter

A

endemic –> goiter due to iodine deficiency
goitrogens
sporadic

33
Q

presentation of diffuse nontoxic goiter

A

euthyroid

sx due to mass effect:
dysphagia
hoarseness
stridor
SVC syndrome
34
Q

multinodular goiters

A

occur due to hyperplasia and regression cycle
may have neoplastic nature
produce mass effect

35
Q

which nodules are more likely to be benign: hot or cold

A

hot –> tx with excision or ablation

36
Q

benign thyroid nodules

A

hyperplastic/adenomatoid nodules

follicular adenoma

37
Q

malignant thyroid nodules

A

papillary thyroid CA
follicular/Hurthle cell CA
anaplastic CA
medullary CA

38
Q

most common malignant thyroid tumor

A

papillary thyroid carcinoma

39
Q

papillary thyroid CA mutations

A

RET-PTC

BRAF

40
Q

histo of papillary thyroid CA

A

papillary architecture
psammoma bodies
“orphan annie eye nuclei”

41
Q

papillary CA variants

A

follicular variant
tall cell variant
diffuse sclerosing

42
Q

papillary CA follicular variant

A

follicular architecture but nuclear features of papillary

RAS mutation

43
Q

papillary CA tall cell variant

A

older patients
aggressive!

histo looks like columnar cells

44
Q

papillary CA diffuse sclerosing variant

A

kids and young adults

risk of metastasis but good prognosis overall

45
Q

follicular CA

A

more common in areas with iodide deficiency

RAS mutation
PAX8/PPARG mutations

46
Q

invasion properties of follicular CA

A

invasion of the capsule (mushroom)

angioinvasion (hematogenous mets)

47
Q

anaplastic CA

A

very uncommon
occurs in elderly patients
highly aggressive and presents with mass effect

TP53 mutation

48
Q

thyroid C cells

A

responsible for calcitonin secretion

49
Q

medullary carcinoma

A

neuroendocrine tumor derived from C cells:
blue cells with dispersed chromatin
amyloid
C-cell hyperplasia

RET mutation

ENRP Exam 2 (11 decks)

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