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Pathology 2 Thyroid, ParaTh, Adrenals > Thyroid Gland Disorders 2 > Flashcards

Thyroid Gland Disorders 2 Flashcards

1
Q

What are the 4 categories of thyroid disorders?

A
  1. Congenital anomalies
  2. Those associated with excessive release of thyroid hormone (Hyperthyroidism)
  3. Those associated with thyroid hormone deficiency (Hypothyroidism)
  4. Tumors of thyroid.
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2
Q

what are the congenital thyroid anomalities?

A

lingual thyroid

Thyroglossal duct cyst

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3
Q

what is Lingual thyroid?

what are the Clinical findings?

A

Failed descent of thyroid anlage from the base of the tongue

  • Dysphagia for solids
  • Mass lesion
  • I 131 scan locates the lesion
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4
Q

what is Thyroglossal duct cyst?

how does it present?

what are the complications?

A

Occurs if the thyroglossal duct fails to atrophy.

May present as a cystic midline mass anterior to trachea.

  • May get infected and lead to an abscess
  • May give rise to carcinoma.
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5
Q

what are the diseases where thyroid hormone is made in excess?

A

Thyrotoxicosis

Hyperthyroidism

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6
Q

what is thyrotoxicosis?

A

Clinical, physiological and biochemical findings in response to elevated thyroid hormone levels regardless of cause

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7
Q

what is hyperthyroidism?

A

thyroid hormone excess due to hyperfunction of thyroid gland

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8
Q

Increased basal metabolic rate due to excess thyroid hormone will cause what changes in na/k atpase, O2, respiration, heat, cardiovascular?

A

Increased Na+/K+ ATPase activity

Increased oxygen consumption

Increased respiration

Heat generation

Increased cardiovascular activity

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9
Q

Increased beta adrenergic receptor synthesis will cause what changes?

A

Increased sympathetic activity

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10
Q

what is 1ry Hyperthyroidism?

A
  • Hyperthyroidism due to intrinsic thyroid abnormality.
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11
Q

what are examples of 1ry hyperthyroidism?

A

Examples:

  • Graves’ disease (most common cause)
  • Toxic multinodular goiter
  • Toxic thyroid adenoma
  • Thyroiditis
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12
Q

what is 2ry hyperthyroidism?

give an example of a cause

A

Hyperthyroidism due to abnormality out side of thyroid.

TSH secreting pituitary tumor

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13
Q

what are Other causes of hyperthyroidism?

A

Struma ovarii – ovarian teratoma with ectopic thyroid

Exogenous administration of thyroid hormone.

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14
Q

General clinical features of hyperthyroidism are due to what?

A
  • Hypermetabolic state
  • Increased activity of sympathetic nervous system (due to increased expression of adrenergic receptors)
  • Increased sensitivity to catecholamines
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15
Q

what are the CVS symptoms of hyperthyroidism?

what patients usually have CVS symptoms?

which symptom is mostly presented?

A
  • Tachycardia, palpitations,Atrial fibrillation
  • Elderly patients may have only CV symptoms, commonly new onset Atrial fibrillation
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16
Q

what are the neuromuscular symptoms of hyperthyroidism?

A
  • Fine tremor of fingers & tongue
  • Anxiety & restlessness, inability to sleep
  • Brisk tendon reflex response
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17
Q

what are the gastrointestinal clinical features of hyperthyroidism?

A
  • Diarrhea
  • Weight loss despite increased appetite and polyphagia
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18
Q

what are the Dermatologic clinical features of hyperthyroidism?

A
  • Warm and moist skin
  • Fine hair
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19
Q

what are the eye clinical features of hyperthyroidism?

what are other clinical features of hyperthyroidism?

A

Wide staring gaze and lid lag

Due to overstimulation of levator palpebrae superioris

Heat intolerance and risk of Osteoporosis, hypocholesterolemia.

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20
Q

what is this feature, and what is it of?

A

wide-eyed staring gaze in hyperthyroidism

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22
Q

what are the lab findings for 1ry hyperthyroidism?

A
  • Free T3 and T4 : increased
  • TSH levels : decreased
23
Q

what are the lab findings for 2ry hyperthyroidism?

A

TSH levels : raised

Increased free T3 and T4

24
Q

what are the clinical features of grave’s disease?

A

Pretibial myxedema

Proptosis (Exophthalmos)

Acropachy

Thyromegaly

25
Q

what is the most common cause of hyperthyroidism and Thyrotoxicosis?

A

graves disease

26
Q

graves disease is genetically..

what locus is it related to?

A

female dominant autoimmune disease

HLA-DR3

27
Q

what happens in graves disease?

A

TSH receptors are perceived as antigens

Thyroid stimulating (IgG) ab (TSI) synthesized against TSH receptorActivate TSH receptors causing excess thyroid hormone secretion resulting in

Hyperthyroidism and

Enlargement of thyroid = thyromegaly.

28
Q

what clinical features will you see in grave’s disease?

A

clinical features of hyperthyroidism + those specific to the disease:

  • Infiltrative Ophthalmopathy: Exophthalmos, Due to glycosaaminoglycans deposited in orbital tissue.
  • Diplopia, conjunctival injection, chemosis, corneal abrasion
  • Pretibial myxedema: raised and hyperpigmented pretibial areas, due to excess GAG in the dermis.
  • Acropachy: separation of nail from nailbed
29
Q

what are the gross findings of graves disease?

what are the micro findings in graves disease?

A

Diffuse, symmetrical, nontender thyromegaly (thyroid enlargement)

Hypertrophy and hyperplasia of follicular epithelium producing:

•Papillary infoldings in the glands

Scant colloid with scalloped margins.

30
Q

what are the laboratory findings in graves disease?

A

Decreased serum TSH (single best test)

Increased free T3 and T4

Increased radioactive iodine uptake

Increased TSI

31
Q

what is the treatment for graves disease?

A
  • Beta blockers: block adrenergic effects of thyroid hormone (symptomatic treatment).
  • Drugs that decrease hormone synthesis:
    • Propylthiouracil (PTU) or methimazole
32
Q

what is Toxic nodular goiter (Plummer’s disease)?

A

One or more nodule in MNG become TSH independent.

  • Secretes excess T3 and T4 causing hyperthyroidism
33
Q

in toxic goiter, if a radionactive scan is made, what will be the findings?

A

hot nodule

34
Q

Patients with toxic goiter do not have signs of what?

A

Exophthalmos and pretibial myxedema.

35
Q

what is a toxic adenoma?

what appears in a radioactive scan?

A

Single nodule in thyroid gland that autonomously release excessive amounts of thyroid hormone

hot nodule

36
Q

what is Struma ovarii?

A

ovarian teratoma made up of thyroid tissue

37
Q

how will hyperthyroidism present in the elderly?

A

Apathetic hyperthyroidism

Cardiac abnormalities - Atrial fibrillation, CHF

Thyromegaly

38
Q

what is Thyrotoxic crisis / Thyroid storm?

A

Acute exacerbation of all the symptoms of thyrotoxicosis presenting in a life threatening state secondary to uncontrolled hyperthyroidism – medical emergency!!!

39
Q

what are the clinical features of thryoid storm?

A
  • Hyperthyroidism
  • Extreme hyperthermia, tachycardia, vomiting, diarrhea, vascular collapse, hepatic failure, jaundice
  • Tachy-arrythmia, congestive heart failure, shock
  • Delirium to coma
40
Q

what will appear in Lab investigations for thyroid storm?

A
  • Increased free T3 and T4
  • Undetectable TSH***
41
Q

what is hypothyroidism?

A

Clinical syndrome caused by reduced secretion of thyroid hormone.

Normal T4, TSH mildly elevated

42
Q

what causess 1ry hypothyroidism?

A

Hashimoto’s thyroiditis ********

Thyroid surgery and or irradiation

Iodine deficiency

Hereditary enzyme defects

43
Q

what causes 2ry hypothyroidism?

A

TSH deficiency = hypopituitarism

44
Q

what causes 3ry hypothyroidism?

A

Thyrotropin releasing hormone deficiency = hypothalamic disease

45
Q

how does Hypothyroidism present in older children and adults?

and in infants and neonates?

A
  • Myxedema in older children or adults
  • Cretinism in neonates and infants
46
Q

what is myxedema?

what can it lead to?

A

Refers to hypothyroidism developing in an adult.

Hashimotos thyroiditis**

47
Q

what are the Clinical Features of early hypothyroidism?

A

Fatigue , constipation and cold intolerance, slowing of mental and physical performance.

48
Q

what are the Clinical Features of late hypothyroidism?

A
  • Weight gain: Due to hypometabolic state with retention of water and salt
  • Mental slowness (forgetful)
  • Dry and brittle hair, loss of lateral aspect of eye brow
  • Deep and hoarse voice, large tongue (macroglossia)
  • Periorbital puffiness ,
  • Pretibial myxedema
  • Slow deep tendon reflexes.
  • Oligomenorrhea , hypercholesterolemia
49
Q

what are the Laboratory findings in myxedema?

what is the treatment?

A

Increased TSH (single best test)

Decreased serum T4 and T3

Levothyroxine

50
Q

what is Cretinism?

another name for this?

A

Hypothyroidism in infancy or early childhood.

congenital hypothyroidism

51
Q

what are the causes for cretinism?

A
  1. Maternal hypothyroidism before development of fetal thyroid gland
  2. Iodine deficiency: during intrauterine and neonatal life.
  3. Maternal use of drugs that block thyroid hormone synthesis.
  4. Deficiency of enzyme necessary for thyroid hormone synthesis.
52
Q

what are the clinical findings of cretinism?

A
  • Severe mental retardation
  • Increased weight &
  • short stature (dwarfism),
  • Coarse facial features,
  • Protuberant abdomen (pot belly)
  • Enlarged tongue
  • Umblical hernia.

Pathology 2 Thyroid, ParaTh, Adrenals (10 decks)

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