Thyroid Anatomy and Pathology II

Question 1

Too much thyroid hormone causes:

1. ___/malingering, for example from a hamburger
2. thyroid gland overproducing hormone.
   - immune cause: ___
   - Autonomous nodules: ___ ___
3. Thyroid gland is releasing stored hormone:
   ex: _____: Leakage of previously stored hormone)
4. Ectopic production of thyroxin:

ex/ ___ ___

5. HCG stimulation seen in a ___ pregnancy

Answer 1

1. IATROGENIC/malingering, for example from a hamburger
2. thyroid gland overproducing hormone.
   - immune cause: GRAVES
   - Autonomous nodules: BENIGN ADENOMA
3. Thyroid gland is releasing stored hormone:
   ex: THYROIDITIS: Leakage of previously stored hormone)
4. Ectopic production of thyroxin:

ex/ OVARY TERATOMA

5. HCG stimulation seen in a MOLAR pregnancy

Question 2

outline the pathomechanism of Graves disease

Answer 2

normally, pituitary gland releases TSH and the it binds to the TSH receptor on the thyroid cell to increase the regulated production of thyroid hormones.

in graves, there is an AUTO-ANTIBODY to the receptor, promoting unregulated overproduction of thyroid hormones

Question 3

microscopic/histological findings of graves disease

Answer 3

you would see infoldings of hyperplastic epihelium.

YOU HAVE A LARGE VASCULAR OVERWORKING GLAND

Question 4

Nodular hyperthyroid Approach:

single nodule; think ___ ___ __. What is this?

if multinodular gland; think a __ ___ disorder

Answer 4

single nodule: BENIGN FOLLICULAR ADENOMA. Autonomous functioning nodule. suppresses rest of thyroid gland (atrophic)

Multinodular gland: - one or more autonomous areas in overal large gland. Long-standing disorder (usually older individuals)

Question 5

Outline findings

Answer 5

thyroid follocular adenoma. Causing hyperfunctioning

Question 6

dietary causes of multinodular goiters

Answer 6

dieteary goitrogens. Cassava, peanuts, etc.

Question 7

outline the natural history of a multinodular goiter

Answer 7

TSH and T4s are normal to begin with, but hormone secretion starts to increase by autonomous follicles that are not well regulated. will result in lower levels of TSH (since you have enough thyroxin), and sky high thyroxin levels, possibly leading to THYROTOXICOSIS

Question 8

which thyroid nuclear scan shows graves disease, toxic adenoma and toxic nodular goiter?

Answer 8

Question 9

Which scan shows thyroiditis

Answer 9

THYROIDITIS: Leakage of previously stored hormone). there is a loss of thyroid hormone trapping

Question 10

In thyroiditis, there is ___ uptake of radioiosine

Answer 10

very low uptake.

Question 11

talk through this table

Answer 11

Question 12

in subacute thyroidisits, the inflammatory process causes a ___ gland that is painful and tender. usually occurs after a viral infection, causing release of pre-fromed and stored thyroid hormone.

Answer 12

hard galnd

Question 13

compare subacute thyroiditis vs graves disease pathomechanism

Answer 13

ST: release of pre-formed and stored thyroid hormone from the colloid. its a SELF LIMITED DISEASE since when the stores are empty, things normalize.

in GRAVES: antibody stimulates new thyroid hormone synthesis and release. hthis is a PROLONGED DISEASE.

Question 14

Question 15

Note

Question 16

underactive thyroid gland:

in adults, most common cause of hypothyroidism is an __ disease called __. Hypopituitary causes 1% of hypothyroidism.

Answer 16

in adults, most common cause of hypothyroidism is an immunological disease called hashmotos. Hypopituitary causes 1% of hypothyroidism.

Question 17

note; for both hyper and hypothyroid disorders, genetics give a predisposition vs environment

Question 18

In Hashimoto’s thyroiditis:

Gland may be __ early in course, __ late in the course, __ to palpation

Answer 18

Gland may be enlarged early in course, atrophic late in the course Firm to palpation

Question 19

Answer 19

Question 20

Ultrasound Key finding that may indicate hashimoto’s

Answer 20

tend to have moth eaten appaeance to lobes