Thyroid and Parathyroid Pathology Flashcards
What is Goitre?
Swelling in the thyroid region in the neck
What is Euthyroid?
Normal function thyroid which is swollen.
Can be diffuse - occurs in younger people.
Multinodular - seen in oldr patients
What are some causes of goitre with hypothyroidism
Iodine Deficiency, drugs (goitrogens) such as lithium, amiodarone or diet substances such as cabbage/turnips.
Describe features of solitary thyroid masses
If benign - movable, soft non-tender.
Malignant - hard nodule, fixated to surrounding tissue and regional lymphadenopathy,
Abscess - Tender and swollen
What are some symptoms of thyroid nodules
Many are asymptomatic but can be exhibit signs and symptoms of altered hormone levels eg, hyperthyroidism (nervousness, heat intolerance, diarrhoea, weight gain) can be hypothyroidism but more rare (cold intolerance, constipation, fatigue, weight gain). Symptoms of local nerve involvement, dysphagia or hoarseness may indicate carcinoma
How can you diagnose a thyroid nodule?
- Thyroid function tests (elevated TSH indicates thyroyditis, low TSH indicates hyperfunctioning nodule),
- Antithyroid bodies,
- FBC - abscess,
- Fine needle aspiration cytology (slightly limited use for diagnosis of type of cancer)
What are some methods of imaging thyroid?
- Ultrasonography (solid? or cystic),
- Radioiodine scintigraphy (determine temp),
- Chest radiography (if malignancy is suspected),
- CT or MRI
What is the commonest cause of hyperthyroidism?
Graves disease which presents as a diffuse toxic goitre. It is an autoimmune condition where IgG binds to TSH receptors on thyrocytes. More common in young women. (uncommon cause - toxic adenoma)
What are the causes of hypothyroidism?
- Congenital,
- Autoimmune (commonest) which results in defective TH production, resulting in loss of parenchyma and deficient TSH)
Describe features of Hashimoto thyroiditis
Chronic autoimmune disease which presents with acute hyperthyroidism at the start but more commonly hypothyroidism.
- Autoreactive CD8 T lymphocytes
- Females aged 30-50
Name some benign and malignant neoplasms
Benign - Follicular adenoma.
Malignant; either primary or metastatic.
Primary is uncommon and can be papillary (thyroid epithelium), follicular (arise from epithelium and therefore carcinoma), anaplastic, medullary (arise from cells producing calcitonin) or lymphoma.
More commonly metastatic lymphoma.
Describe features of follicular adenoma
- Tends to be females 30-50yrs old.
- 1-3cm in size
- Can be functional (thyroxine producing) but not usual
Describe features and causes of papillary carcinoma
- Occurs more common in women (3:1) aged 20-50yrs.
- Caused by radiation, family history or idiopathic.
- Commonly spreads to local lymphnodes
Describe features of follicular carcinomas
- Less common and occurs in 40+ years old (females 3:1).
- Can be difficult to distinguish between adenoma and carcinoma.
- Commonly spreads to blood stream (think bone spread)
Describe features of medullary carcinoma
- Can be familial in younger patients.
