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Thyroid pathology > Thyroid Disorders > Flashcards

Thyroid Disorders Flashcards

1
Q

Each lobe of the thyroid has a

A

Upper middle and lower pole

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2
Q

The right and left lobes of the thyroid gland are connected by a?

A

Isthmus

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3
Q

The thyroid epithelium is composed of?

A

Simple cuboidal to low columnar epithelium

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4
Q

Parafollicular cells (clear cells) are located where?

A

At the periphery

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5
Q

Do the parafollicular cells contact the colloid?

A

No

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6
Q

The parafollicular cells secrete what?

A

Calcitonin

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7
Q

Subclinical hypothyroidism is…?

A

Increased TSH and free T4 level remains in the lower-normal to normal range

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8
Q

Primary hypothyroidism means there is a problem with what structure?

A

The thyroid itself

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9
Q

Seconday hypothyroidism is…?

A

An inadequate stimulation by TSH that ends up in a deficient thyroid gland function

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10
Q

What is the most common cause of primary hypothyroidism in North America?

A

Hashimotos thyroiditis

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11
Q

What are other causes of primary hypothyroidism?

A

Thyroid agenesis
Inborn errors of thyroid metabolism
Anti-microsomal, antithyroid peroxidase, and antithyroglobulin
Surgical/radiation/drugs

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12
Q

What germline mutations are associated with primary hypothyroidism?

A

FOXE1, PAX8, and THRB

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13
Q

What gene increases the risk for follicular carcinoma?

A

PAX8

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14
Q

Cretinism is mostly associated with?

A

Endemic iodine deficiency

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15
Q

What are some clinical features of children with cretinism?

A

Growth retardation, mental retardation, proturding tongue, umbilical hernia, coarse facial features

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16
Q

What other symptoms can children with hypothyroidism exhibit?

A

Pseudohypertrophy of the muscle (it is really fat)

Precocious or delayed puberty

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17
Q

Myxedema can be found in?

A

Hypothyroidism

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18
Q

Myxedema is due to?

A

Deposition of glycosaminoglycans

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19
Q

Overt primary hypothryroidism is characterized by an elevated TSH level of what?

A

More than 10 mIU/L and free T4 levels below the lower limit of the reference range

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20
Q

T4 levels in subclinical hypothyroidism remain where?

A

Low normal to normal range

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21
Q

In secondary or central hypothyroidism deficient thyroid gland function is due to

A

Inadequate stimulation of TSH

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22
Q

In secondary or central hypothyroidism we are going to have a low or normal what

A

TSH

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23
Q

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

A

Hashimotos thyroiditis?

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24
Q

Hashimotos thyroiditis may occur in association with?

A

Autoimmune polyendocrine syndrome types 1 and 2

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25
Q

Does Hashimotos thyroiditis have a strong genetic component?

A

Yes

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26
Q

In Hashimotos thyroiditis there are circulating autoantibodies that are called?

A

Anti thyroglobulin and anti thyroid peroxidase

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27
Q

Autoantibodies against the sodium iodide symporter and pendrin have been found in a minority of patients with?

A

Hashimotos thyroiditis

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28
Q

What are some non endocrine disorders associated with Hashimotos ?

A

SLE, myastenia gravis, Sjogern syndrome

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29
Q

Which polymorphomisms in immune regulation-associated genes increase a persons susceptibility for Hashimotos?

A

CTLA4 and PTPN22 (polymorphomisms in these genes)

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30
Q

In Hashimotos disease there is a transient what?

A

Hyperthyroidism initially

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31
Q

In Hashimotos disease there is destruction of the follicular cells by what cells?

A

CD8+ T cells

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32
Q

In Hashimotis disease there is production and release of inflammatory cytokines by what?

A

Activated CD4+ T cells

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33
Q

In Hashimotos disease, painless enlargment of the thyroid may precede what?

A

Systemic manifestations

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34
Q

In Hashimotos disease, enlargment of the thyroid gland is?

A

Symmetric and diffuse

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35
Q

In ultrasound diffuse heterogeneity suggests what?

A

Autoimmune thyroiditis

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36
Q

In Hashimotos thyroiditis, the gland tends to enlarge in what way?

A

Symmetrically

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37
Q

Epithelial cells in Hashimotos thyroiditis undergo what?

A

Hurthle cell change

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38
Q

What lymphocytes can be found in Hashimotos thyroiditis?

A

CD8 and CD4 T cells

Also germinal centers

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39
Q

Painless and postpartum thyroiditis are variants of what?

A

Autoimmune thyroiditis

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40
Q

what is an important difference between Hashimotos disease and subacute lymphocytic painless thyroiditis?

A

Fibrosis and Hurthle cell metaplasia are not prominent in lymphocytic painless thyroiditis

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41
Q

In subacute granulomatous thyroiditis there is painful ….

A

Enlargement of the gland

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42
Q

In granulomatous thyroiditis there is transient inflammation and…

A

Hyperthyroidism

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43
Q

In subacute granulomatous thyroiditis there is decreased what?

A

Radioactive iodine uptake when compared to Graves disease

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44
Q

In subacute granulomatous thyroiditis there is…

A

Unilateral or bilateral glandular growth

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45
Q

What can be found in the early inflammatory phase of subacute granulomatous thyroiditis?

A

Scattered follicles may be disrupted and replaced by neutrophils forming microabscesses

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46
Q

What can be found in the later phase of subacute granulomatous thyroiditis?

A

Aggregates of lymphocytes, activated macrophages, and plasma cells associated with collapsed and damaged thyroid follicules, multinucleated giant cells surround fragments of colloid, chronic inflammatory infiltrate and fibrosis may replace the foci of injury

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47
Q

Thyrotoxicosis is caused by?

A

Excessive thyroid hormone

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48
Q

Hyperthyroid disorders can be classified into what categories?

A

Primary and secondary

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49
Q

What are some primary causes of hyperthyroidism?

A

Graves disease, hyper-functional toxic multinodular goiter, hyperfunctional toxic adenoma

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50
Q

What are some secondary causes of hyperthyroidism?

A

TSH secreting pituitary adenoma, ingestion of thyroid hormone

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51
Q

Graves disease is characterized by?

A

Hyperthyroidism, opthalmopathy, and dermopathy (pretibial myxedema)

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52
Q

Graves disease is the most common cause of?

A

Endogenous hyperthyroidism

53
Q

Graves disease is more common in women or men?

A

Women

54
Q

What is the pathogenesis of Graves disease?

A

The production of thyroid-stimulating immunoglobulins that bind to and activate TSH receptors

55
Q

What are some characteristics of opthalmopathy in Graves disease?

A

Eyelid retraction, perioribital edema, episcleral vascular injection, conjunctival swelling, proptosis (exopthalmos)

56
Q

Pretibial myxedema happens when?

A

There is a deposition of glycosaminoglycans in the dermis of the skin

57
Q

How does pretibial myxedema look like?

A

Mildly pruritic, orange peel-like thickening of the skin along the anterior aspects of the shins

58
Q

What is an important diagnosis when it comes to Grave’s disease?

A

Fractional 24 hour radioiodine uptake

59
Q

What diagnostic method can confirm the presence of solitary or multiple thyroid nodules?

A

Thyroid ultrasonography

60
Q

In Grave’s disease the thyroid enlargment is…?

A

symmetrical and secondary to diffuse hypertrophy and hyperplasia of thyroid follicular epithelial cells

61
Q

The thyroid of someone with Grave’s disease has a

A

meaty apperance on a cut section

62
Q

In Grave’s disease, what can be found in the microscopic morphology?

A

Tall, crowded follicular cells, pale colloid centers, presence of small clear vacoules on the edge of the colloid

63
Q

Colloid goiter is known as ?

A

Diffuse nontoxic simple goiter

64
Q

How are the TSH, T3 and T4 levels of someone with colloid goiter?

A

Normal

65
Q

Most symptoms of colloid goiter arise from the?

A

Mass effect

66
Q

A toxic multinodular goiter is charcaterized by the presence of

A

Multiple autonomous functioning thyroid nodules which are capable of synthesizing and secreting excessive amounts of thyroid hormone

67
Q

Toxic multinodular goiter tends to be more common in?

A

Older individuals

68
Q

The enlargment of multinodular goiter is

A

Assymetrical

69
Q

Most patients with multinodular goiter become

A

Euthyroid

70
Q

What does “hot nodules” mean in multinodular goiter?

A

increased activity on radionuclide scintigraphic scanning

71
Q

Most thyroid nodules represent

A

Small, benign adenomatoid nodules or cysts

72
Q

Does a personal family history of therapeutic neck irradiation in childhood presents a risk for malignancy?

A

Yes

73
Q

Medullary thyroid cancer is familial in

A

50% of cases

74
Q

Medullary thyroid cancer is associated with?

A

Multiple endocrine neoplasia type 2 (MEN-2) syndromes

75
Q

Papillary thyroid cancers are familial in

A

10% of cases

76
Q

Malignancy of thyroid nodules is suggested by?

A

Fixation and ipsilateral regional adenopathy or vocal cord paresis

77
Q

Multinodularity of the gland may reflect a

A

Benign process

78
Q

Low/undetectable levels of TSH may reflect a

A

Toxic adenoma

79
Q

What can an ultrasound of a thyroid do?

A

Confirm that a mass is within a thyroid, accurately defines its size, classifies it as cystic or solid, and determines whether additional nodules are present

80
Q

What is the most accurate test to exclude or confirm malignant disease in patients with a nodule and a normal TSH level?

A

Fine-needle aspiration biopsy

81
Q

Thyroid adenomas are also known as

A

Follicular adenomas

82
Q

In most cases thyroid adenomas are

A

Discrete, solitary masses derived from follicular epithelium

83
Q

In most cases thyroid adenomas are not precursos of carcinomas

A
84
Q

In most cases thyroid adenomas are not precursos to

A

Carcinomas

85
Q

Most thyroid adenomas are not

A

Functional

86
Q

What does a functional adenoma mean?

A

It means that the adenoma is able to increase the thyroid hormone levels independant of TSH

87
Q

Functional adenomas clinically present as

A

Thyrotoxicosis

88
Q

What gain of function mutations are present in thyroid toxic adenomas?

A

TSHR and GNAS mutations

89
Q

The gain of function mutations TSHR and GNAS lead to…

A

Autonomous secretion of thyroid hormone by follicular cells independant of TSH

90
Q

How does a thyroid adenoma look macroscopically?

A

Solitary, spherical, encapsulated well defined lesion

91
Q

How does a thyroid adenoma look like microscopically?

A

Presence of recognizable follicles that are small and packed closely

92
Q

What is the hallmark of all follicular adenomas?

A

Presence of intact well formed capsule encircling the tumor

93
Q

Which two types of thyroid cancer are well differentiated?

A

Papillary carcinoma

Follicular carcinoma

94
Q

Which two types of thyroid carcinomas are not well differentiated?

A

Anaplastic

Medullary carcinoma

95
Q

Papillary carcinomas involve a gain of function mutation in which genes?

A

RET or NTK1 receptor tyrosine kinase
Serine/threonine kinase BRAF
Both mutations set off a signaling cascade down the MAPK pathway

96
Q

Follicular carcinomas are associated with point mutations where?

A

RAS and PI3K which increase PI3K/AKT/mTOR pathway

97
Q

Loss of function mutations in which gene salso play a role in the pathogenesis of follicular carcinoma?

A

PTEN

98
Q

Follicular carcinomas are associated with what type of mutations?

A

Point mutations in RAS and PI3K which increase the PI3K/AKT/mTOR pathway

99
Q

Loss of function mutations in which gene play a role in the pathogenesis of follicular carcinomas?

A

PTEN

100
Q

Anaplastic carcinomas may arise

A

De novo

101
Q

Anaplastic carcinomas have mutations in

A

RAS or PIK3CA mutations

102
Q

In anaplastic carcinomas there is a loss of function of which gene?

A

TP53

103
Q

Anaplastic carcinomas have activating mutations of

A

Beta-catenin

104
Q

Medullary carcinomas occurr in

A

Multiple endocrine neoplasia type 2

105
Q

What type of mutations are present in medullary carcinomas?

A

Germline RET mutations

106
Q

Papillary carcinomas are the most

A

Popular type of thyroid carcinoma

107
Q

Previous exposure to ionizing radiation is the main risk factor for?

A

papillary carcinoma

108
Q

Papillary carcinomas have an excellent

A

Prognosis with a 10 year survival rate

109
Q

Most papillary carcinomas present as

A

Asymptomatic thyroid nodules

110
Q

In some people, the first manifestation of papillary carcinoma may be

A

A mass in a cervical lymph node

111
Q

In papillary carcinomas, does the presence of isolated cervical nodal metastases have a significant influence on prognosis?

A

No

112
Q

What are some symptoms of advanced papillary carcinoma?

A

Hoarseness, dysphagia, cough, and dyspnea

113
Q

Which thyroid carcinoma are cold masses on scintiscans?

A

Papillary carcinoma

114
Q

What are some morphological characteristics of papillary carcinoma?

A

Some are well demarcated and capsulated
Some are infiltrative to the adjacent parenchyma and unevely formed
Fibrosis, calcifications, and cystic changes may be present

115
Q

Microscopically, papillary carcinomas have a branching papillar with a

A

Fibromuscular stalk

116
Q

The branching papillae in papillary carcinoma are covered with

A

single to multiple layers of cuboidal epithelial cells

117
Q

The nuclei of papillary carcinomas contain finely disperesed

A

Chromatin

118
Q

How does the nuclei of papillary carcinoma cells look like?

A

Optically clear or empty apperance

-Orphan Annie eye

119
Q

In papillary carcinoma, invaginations of the cytoplasm

A

may give the apperance of nuclear inclusions

120
Q

Papillary carcinomas have what type of bodies?

A

Psamomma bodies

121
Q

Follicular carcinomas are associated with increased incidence of

A

Iodine deficiency

122
Q

Follicular carcinomas are more common in

A

Older patients

123
Q

The prognosis of follicular carcinoma depends on

A

The extent of invasion and stage at presentation

124
Q

Widely invasive follicular carcinomas are usually accompanied by

A

Metastases

125
Q

How do follicular carcinomas typically present?

A

Slowly enlarging painless nodules

126
Q

Are regional lymph nodes rarely involved in follicular carcinomas?

A

Yes

127
Q

Is hematogenous dissemination common in follicular carcinomas?

A

Yes

128
Q

To which organs do follicular carcinomas spread to?

A

Bone, lungs, liver and elsewhere

129
Q

Follicular carcinomas typically present as

A

Cold nodules , however better differentiated lesions may be hyperfunctional

Thyroid pathology (1 decks)

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