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MD4001 Pathology > Thyroid and Parathyroid Pathology > Flashcards

Thyroid and Parathyroid Pathology Flashcards

1
Q

What is a ‘goitre’?

A

Swollen, enlarged thyroid gland

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2
Q

What is euthyroid?

A

Normal thyroid gland function

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3
Q

What people get a diffuse goitre thyroid?

A

Yonger people

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4
Q

What people get a multinodular goitre thyroid?

A

Older people

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5
Q

What can cause hypothyroidism?

A

Iodine deficiency - endemic (seaweed may cause hyperthyroidism)

Goitrogens

  • Drugs - Lithium, amiodarone
  • Diet - cabbage, turnips
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6
Q

What is the most common drug that can cause goitre?

A

Lithium

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7
Q

What can the pathogenesis of hypothyroidism be?

A
  • Reactive
  • Iodine block
  • Genetic
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8
Q

How do benign masses and malignancies differ in the thyroid on inspection?

A
  • Benign masses are usually movable, soft and non-tender

- Malignancy is associated with a hard nodule, fixation to surrounding tissue, and regional lymphadenopathy

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9
Q

What are the signs and symptoms of hyperthyroidism?

A
  • Nervousness
  • Heat intolerance
  • Diarrohea
  • MUscle weakness
  • Loss of weight and apetite
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10
Q

What are the signs and symptoms of hypothyroidism?

A
  • Cold intolerancce
  • Constipation
  • Fatigue
  • Weight gain
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11
Q

What are signs / symptoms of local nerve involvement in a thyroid pathology?

A
  • Dysphagia and hoarsness

- Could be a sign of malignancy

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12
Q

What do the follicles look like on histology in multinodular goitre?

A

Different sizes

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13
Q

How is a thyroid pathology diagnosed?

A
  • Thyroid function test
  • Antithyroid antibodies
  • Complete blood count
  • Fine needle aspirate
    Imaging
  • Ultrasnogtophy
  • Radioiodine scintigraphy
  • Chest radiography
  • CT, MRI
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14
Q

What may an elevated thyroid-stimulating hormone (TSH) indicate?

A

Thyroiditis

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15
Q

What may a very low TSH level indicate?

A

An autonomous or hyperfunctioning nodule

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16
Q

What are antithyroid antibodies helpful in?

A

Diagnosing chronic lymphocytic thyroiditis (Hashimoto thyroiditis)

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17
Q

What can a solitary thyroid nodule be?

A
  • Abcess

- Thyroid pathology

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18
Q

What are the diseases of the thyroid?

A
  • Trauma
  • Toxicity (lithium)
  • Goitre, solitary nodule, neoplasms
  • Chronic inflammation - immune or not
  • Acute thyroiditis, abscess
  • Metabolic, genetic
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19
Q

What is the classic sign of an overactive thyroid?

A

Exophthalmos (buldging of the eye) (build up of fatty tissue pushing eyeball forward)

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20
Q

What is the most common cause hyperthyroidism?

A
  • Graves (may present as diffuse toxic goitre)
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21
Q

What can cause hyperthyroidism?

A
  • Graves
  • Functional goitre
  • Toxic adenoma
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22
Q

What can cause hypothyroidism?

A
  • Congenital

- Autoimmune (commonest in adults)

23
Q

What happens in hypothyroidism?

A
  • Defective TH production
  • Loss of parenchyma
  • Deficient TSH
24
Q

What is graves disease caused by?

A
  • IgG against TSH receptor on thyrocytes
  • Antibody is not compliment fixing IgG class 2 or 4 not 1 or 3
  • Mimics TSH
25
Q

What gender is more likely to get Graves disease?

A

female - 10:1 over males

26
Q

What may Graves disease present as?

A

Diffuse toxic goitre

27
Q

What genes may cause graves?

A

Strong family history HLA DR3 and CTLA-4

28
Q

What group of people are most likely to be affected by Hashimoto thyroiditis?

A

Female 30-50 (again ~ 10:1 ratio against males)

29
Q

Describe the pathogenesis of Hashimoto thyroiditis?

A
  • Autoreactive CD8 T lymphocytes
  • Autoreactive antibodies: thyroid microsomal in almost all 95% thyroglobulin in 2/3s, minority have blocking TSH receptor antibodies
  • Can cause hyper or hypothyroidism (primarily hypothyroidism)
30
Q

What may the thyroid gland look and feel like in hashimoto thyroiditis?

A
  • Multinodular
  • Shrunken
  • Hard
  • Fibrotic
  • Scarring
31
Q

What can cause hashimoto thyroiditis?

A
  • FH (like many autoimmune diseases)
  • Increased iodine intake
  • Viral infection
32
Q

What is a long term risk of hashimoto thyroiditis?

A

Lymphoma

33
Q

What are benign neoplasms of the thyroid?

A

Follicular adenoma

34
Q

What are malignant neoplasms of the thyroid?

A
  • Primary about 1% of cancers; papillary, follicular, anaplastic, medullary (parafollicular cells), lymphoma
  • Metastic: Lymphoma
35
Q

Who is likely to be affected by follicular adenomas?

A

Females: 30 - 50 years

36
Q

How large are the follicular adenomas usually?

A

1 - 3 cm at presentation (small, incapsulated, not usually invasive)

37
Q

What is the most common cause of thyroidd cancer?

A

Papillary carcinoma (80%)

38
Q

What group does papillary carcinoma affect?

A

Females (3:1) 20 - 50 years

39
Q

What are the causes of papillary carcinomas?

A
  • Radiation (Chernobyl)
  • Family History
  • Unknown
40
Q

What genes can cause papillary carcinoma?

A
  • Rearrangement of RET oncogene in most

- B-RAF mutation in half - associated with increased risk of LN mets

41
Q

What does papillary carcinoma look like upon histology?

A

Instead of having pattern of regular follicles follicle linings become complex and branched forming papillary
- Gobs of calcium also present

42
Q

What percentage of thyroid cancers are follicular carcinomas?

A

20%

43
Q

What group does follicular carcinomas affect?

A
  • Females:Males (3:1)

- Older than 40

44
Q

What genes can cause follicular carcinoma?

A
  • RAS oncogene

- PAX8/PPARG rearrangement

45
Q

How can folllicular carcinoma spread?

A
  • Minimally invasive versus invasive

- Blood spread may present in bone marrow

46
Q

What is anaplastic carcinom?

A
  • Less common
  • p53 mutation common
  • May have had previous thyroid neoplasia
  • Half have had chronic goitre
  • Female:Male 4:1
47
Q

What cells are attacked in medullary carcinoma?

A

Parafollicular cells (tumors can produce amyloid instead of calcitonin)

48
Q

What genes can be involved in medullary carcinoma?

A

RET proto-oncogene activation (20% familial, in youngeer patients)

49
Q

What are the causes of primary hyperparathyroidism?

A
  • Adenoma (4/5s)
  • Hyperplasia (some familial)
  • Parathyroid carcinoma (less than 1%)
50
Q

What are the causes of secondary hyperparathyroidism?

A
  • Caused by low calcium (e.g chronic renal failure and vitamin D deficiency)
51
Q

What are the causes of tertiary hyperparathyroidism?

A

Raised caclcium in secondary

52
Q

What are the effects of hypercalcaemia?

A
  • Emotional disorders
  • Muscle atrophy
  • Parathyroid adenoma or hyperplasia
  • Osteitis fibrosa cystica
  • Peptic ulcer
  • Pancreatitis
  • Kidney stone
  • Nephrocalcinosis
  • Arrhythmia
  • Calcification of blood vessels
53
Q

What cancer can cause hyperparathyroidism?

A

Small cell lung cancer

54
Q

What is multiple endocrine neoplasia?

A
  • Genetically inherited (MEN1 and MEN2)
  • Associated with tumours in the endocrine organs (specifically parathyroid and neuroendocrine cell and parafollicular calcitonin producing cell in thyroid)

MD4001 Pathology (18 decks)

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