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Endocrine Pathology > Thyroid Disorders > Flashcards

Thyroid Disorders Flashcards

1
Q

Thyroid glands store its secretory substances in the lumen of

A

Follicles

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2
Q

The follicular cells are made up of what type of epithelium?

A

Cuboidal to low columnar epithelium

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3
Q

Follicular cells surround a central

A

Colloid filled lumen

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4
Q

Parafollicular cells are also known as

A

Clear cells or C cells

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5
Q

Where are the parafollicular cells located and do they contact the colloid?

A

Periphery and No

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6
Q

T4 and T3 are stored where? and to which molecule are they attached?

A

In the colloid

Thyroglobulin

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7
Q

Calcitonin opposes what other hormone?

A

PTH

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8
Q

Parafollicular cells secrete

A

Calcitonin

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9
Q

What symporter actively transports iodide into the thyrocyte?

A

sodium-iodide symporter

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10
Q

Within the thyrocyte iodide is rapidly oxidezed by what molecule? with the help of which enzyme?

A

H2O2 /thyroid peroxidase

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11
Q

The oxidized iodide is added to which residues in thyroglobulin?

A

tyrosyl residues

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12
Q

Which enzyme catalyzes the coupling of the monoidotyrosine and diiodotyrosine to generate T4 and T3?

A

thyroid peroxidase

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13
Q

TRH is secreted by?

A

Hypothalamus

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14
Q

What is primary hypothyroidism?

A

Hormone deficiency secondary to an intrinsic thyroid gland dysfunction

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15
Q

What is secondary hypothyroidism?

A

An inadequate stimulation by TSH results in a deficient thyroid gland function

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16
Q

Sexondary hypothyroidism can also be due to

A

Inadequate TRH

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17
Q

Thyroid agenesis/hypoplasia is associated with what germline mutations?

A

FOXE1, PAX8, and THRB

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18
Q

Can hypothyroidism be the result of drugs?

A

Yes

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19
Q

A mutation in which gene increases the risk for follocular carcinoma?

A

PAX8

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20
Q

How can the neck present in someone with hypothyroidism?

A

Thyroid gland may be normal in size, diffusely enlarged or atrophic, may be soft and smooth with a lobular texture, or firm and irregular with a variegated nodular texture

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21
Q

What is overt primary hypothyroidism?

A

Elevated TSH level >10 mIU/L plus free T4 level below the lower limit of the reference range

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22
Q

What is subclinical hypothyroidism?

A

Free T4 level remains the low normal to normal range while the TSH is high

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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 polyendrocrine syndrome (APS) types 1 and 2

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25
Q

What are other types of thyroiditis?

A

Granulomatous (de quervain) thyroiditis and subacute lymphocytic thyroiditis

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26
Q

Hashimotos thyroiditis is more prevalent in which gender?

A

Women

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27
Q

Hashimotos thyroiditis is characterized by circulating autoantibodies against?

A

Thyroglobulin and thyroid peroxidase

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28
Q

During Hashimotos thyrotoxicosis how are the levels of T3, T4 and TSH?

A

TSH is decreased, T3 and T4 is increased and also radioactive iodine uptake is decreased

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29
Q

In Hashimotos thyroiditis, painless enlargment of the gland may precede what?

A

Systemic manifestations

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30
Q

Enlargment of the gland of someone with Hashimotos thyroiditis is…

A

Symmetric and diffuse

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31
Q

In Hashimotos thyroiditis, the thyroid gland eventually…

A

Atrophies

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32
Q

What other labs should be done in a person with Hashimotos thyroiditis aside from TSH/T4 and T3?

A

Antithyroid peroxidase antibody, antithyroglobulin antibody and also an ultrasound

Diffuse heterogeneity on ultrasound suggests autoimmune thyroiditis

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33
Q

In Hashimotos thyroiditis, epithelial cells undergo ?

A

Hurthle cell change

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34
Q

Subacute lymphocytic thyroiditis and postpartum thyroiditis are variants of?

A

Autoimmune thyroiditis

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35
Q

In subacute lymphocytic thyroiditis as well as postpartum thyroiditis, how do patients intially present?

A

Mild hyperthyroidism, goitrous enlargment of the gland or both

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36
Q

In subacute thyroiditid and postpartum patients tend to transition from hyperthyroidism to

A

Hypothyroidism before recovery

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37
Q

What is a key difference between hashimotos thyroiditis and subacute lymphocytic and postpartum thyroiditis?

A

In subacute lymphocytic thyroiditis as well as postpartum thyroiditis, there is a lack of fibrosis and Hurthle cell metaplasia is not prominent

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38
Q

What triggers subacute granulomatous thyroiditis?

A

Viral infection

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39
Q

Subacute granulomatous thyroiditis is also called…

A

De Quervain thyroiditis

40
Q

In subacute granulomatous thyroiditis there is painful what?

A

Enlargment of the thyroid gland

41
Q

For how long does the transient hyperthyroidism state lasts in granulomatous thyroiditis?

A

2-6 weeks

42
Q

How do the T4, T3 and TSH look like during the hyperthyroid state of someone with granulomatous thyroiditis?

A

High T4 and T3, low TSH and decreased radioactive iodine uptake

43
Q

How does thr gland of someone with subacute granulomatous thyroiditis look like?

A

Unilateral or bilateral glandular growth

Firm consistency and intact capsule with capability of adhering to adjacent structures

44
Q

What can be found microscopically in the early and late phases of inflammatory phase of subacute granulomatous thyroiditis?

A

Neutrophils forming microabscesses -early phase

Later phase- aggregates of lymphocytes, activated macrophages, and plasma cells associated with collapsed and damaged thyroid follicles

Multinucleated giant cells surround fragments of colloid
Chronic inflammatory infiltrate and fibrosis may replace the foci of injury

45
Q

What are some causes of primary hyperthyroidism?

A
  1. Grave’s disease
  2. Hyper-functional toxic multinodular goiter
  3. Hyperfunctional toxic adenoma
46
Q

What are some causes of secondary hyperthyroidism?

A
  1. TSH-secreting pituitary adenoma

2. Ingestion of exogenous thyroid hormone

47
Q

What are some examples of ophthalmopathy in Grave’s disease?

A

Eye lid retraction, perioribital edema, episcleral vascular injection, conjunctival swelling (chemosis), proptosis (exopthalmos)

48
Q

What is pretibial myxedema?

A

A condition that is precipitated by the deposition of glycosaminoglycans in the dermis of the skin

49
Q

How do patients with pretibial myxedema present?

A

Midly pruritic, orange peel-like thickening of the skin along the anterior aspeft of the shins

50
Q

A low TSh and increased free T4 is indicated of?

A

Thyrotoxicosis

51
Q

A decreased TSH and a normal free T4 is indicative of what conditions?

A

T3 thyrotoxicosis
Mild or subclinical thyrotoxicosis
Nonthyroidal illness

52
Q

A normal to increased TSH and an increased free T4 is indicative of what?

A

TSH-secreting pituitary adenoma
Thyroid hormone resistance syndrome
Familial dysalbuminemic hyperthyroxinemia

53
Q

What important diagnosis is made in Grave’s disease?

A

Fractional 24-hour radioiodine uptake which is going to fire up.

Also, a thyroid ultrasonography can confirm the presence of solitary or multiple thyroid nodules

54
Q

How is the morohology of the thyroid of someone who has Grave’s disease?

A

Enlargment of the thyroid is usually symmetrical. This is secondary to diffuse hypertrophy and hyperplasia of thyroid follicular epithelial cells

55
Q

How does the microscopic morphology look like in someone who has Grave’s disease?

A

Tall crowded follicular cells which may result in the formation of small papillae (without fibrovascular cores)
-pale colloid centers
Presence of small, clear vacoules on the edge of the colloid

56
Q

Colloid goiter is also known as

A

Diffuse non toxic sinple goiter

57
Q

Colloid goiter is distributed in an

A

Endemic and sporadic fashion

58
Q

Most patients that present these nontoxic goiters are

A

Eurhyroid

-The TSH, T3 and T4 levels tend to be in a normla range

59
Q

Most symptoms of someone who has a colloid goiter tend to come from?

A

The mass effect of the goiter

60
Q

Endemic goiter is associated with

A

Endemic iodine deficiency

61
Q

The deficiency of iodine in endemic goiter leads to

A

A decreased synthesis of thyroid hormones which leads to an increase in TSH

62
Q

Patients with endemic goiter develop what?

A

Follicular cell hypertrophy and hyperplasia and goitrous enlargment

63
Q

How will the thyroid follicules of someone with goiter look like?

A

Thyroid follicles are lined with inactive, flattened epithelial cells and filled with abundant stored colloid

64
Q

What is toxic multinodular goiter?

A

Characterized by the presence of multiple autonomously functioning thyroid nodules

65
Q

The nodules in a person with toxic multinodular goiter are capable of?

A

Synthesizing and secreting excessive amounts of thyroid hormone

66
Q

Toxic multinodular goiter is more common amongst the

A

Older population

67
Q

The enlargment of the thyroid gland of someone who has multinodular goiter is?

A

Assymetric although both lobes are enlarged

68
Q

Most patients with multinodular goiter are

A

Eurhyroid

69
Q

What does “hot nodules” mean?

A

Increased activity on radionuclide scintigraphic scanning

70
Q

Functional nodules have a

A

Less risk of malignancy than cold nodules

71
Q

If there is a personal history of neck irradiation in childhood this increases the risk for

A

Malignancy of thyroid nodules

72
Q

Medullary thyroid cancer is familial in

A

50% of cases

73
Q

Medullary thyroid cancer are associated with

A

Multiple endocrine neoplasia type 2 (MEN 2)

74
Q

Papillary thyroid cancers are familial in

A

10% of cases

75
Q

A well perfomed physical examination of thyroid nodules should define

A

Size, consistency, surface texture, mobility and tenderness

76
Q

Malignancy of thyroid nodules of suggested by

A

Fixation and ipsilater regional adenopathy or vocal cord paresis

77
Q

Multinodularity of the thyroid gland may reflect a

A

Benign process

78
Q

A toxic adenoma will have a

A

Decreased level of TSH which means it is benign and autonomoulsy functioning

79
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 biopsy

80
Q

Ultrasonographic guidance and on-site preliminary cytologic assesment can improve the yield of biopsy when it comes to

A

Thyroid nodules

81
Q

Thyroid adenomas in most cases are

A

Discrete, solitary masses derived from follicular epithelium

82
Q

In most cases thyroid adenomad are kot precursors to

A

Carcinomas

83
Q

Modt thyroid adenomas are

A

Non functional meaning that they do not secrete T3 and T4 independantly from TSH

84
Q

Toxic adenomas are due to

A

Gain of function mutations of the TSH receptor signaling

TSHR and GNAS mutations

85
Q
A

R

86
Q

How do the adenomas look macroscopically?

A

Solitary, spherical, encapsulated well defined lesion

87
Q

Thyroid adenomas have small

A

Follicles that are packaged closely

88
Q

What is the hallmark of all follicular adenomas?

A

Presence of an intact well formed capsule encircling the tumor

89
Q

Thyroid adenomas may undergo

A

Hurthle change

90
Q

Which thyroid carcinoma is poorly differentiated?

A

Anaplastic

91
Q

Medullary carcinomas are

A

Undifferentiated

92
Q

Papillary and follicular carcinomas are

A

Well differentiated

93
Q

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

A

RET or NTRK1

BRAF

94
Q

Both mutations (RET or NTRK1 or BRAF) set off a signaling cascade down the

A

MAPK pathway

95
Q

In papillary carcinomas there is

A

Either a paracentric inversion of chromosome 10 or a reciprocal translocation between chromosomes 10 and 17

96
Q

The chromosomal rearrnagment in papillary carcinoma activates the

A

Transcription of the RET tyrosine-kinase domain in follicular cell which triggers signaling along the MAPK pathway and an uncontrolled proliferation

Endocrine Pathology (3 decks)

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