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Endocrine II AH > Thyroid - Guerin > Flashcards

Thyroid - Guerin Flashcards

1
Q

Goiter is caused by what?

What thyroid state?

A

Impaired synthesis of thyroid hormone, most often result of dietary iodine deficiency

Euthyroid

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2
Q

What feature of follicular variant PTC makes it aggressive?

A

Poorly circumscribed and infiltrative

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3
Q

Hashimoto’s is associated with polymorphisms in what?

A

CTLA4 and PTPN22

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4
Q

Secondary (pituitary-associated) cause of hyperthyroidism may be excluded with what?

A

TRH stimulation test

Normal rise in TSH after admin TRH excludes secondary causes

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5
Q

Peak age of Graves?

Triad of CF?

A

20-40

Hyperthyroidism w/big gland, exophthalmos, dermopathy (pretibial myxedema)

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6
Q

What tumor marker is helpful in monitoring sporadic medullary carcinoma?

Diarrhea may be caused due to what?

A

CEA

VIP

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7
Q

What is apathetic hyperthyroidism?

Lab tests?

A

Thyrotoxicosis in older adults

Low TSH, high T4

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8
Q

What clues tell you a thyroid nodule is more likely neoplastic?

A

Male
Younger pt
Solitary nodule
Hx of radiation to H and N

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9
Q

What presents w/painless mild hyperthyroidism and goitrous enlargement in middle-aged pts?

Have what circulating?

Up to 1/3 evolve into what?

A

Subacute lymphocytic thyroiditis (occurs in 5% postpartum)

Antithyroid peroxidase Abs

Over hypothyroidism

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10
Q

What is a thyroglobulin duct cyst?

A

Vestige of the tubular thyroid leading to a persistent sinus tract

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11
Q

Granulomatous (De Quervain) thyroiditis affects who?

Triggered by what?

Common when?

A

W 40-50 y/o

Viral infection (uri)

Summer

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12
Q

Mean age of anaplastic carcinoma?

Prognosis?

A

65

Highly aggressive, 100% mortality

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13
Q

What temperature sensation is common with hyperthyroidism?

A

Heat intolerance (always feel hot)

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14
Q

Thyroglossal duct cysts high in the neck are lined by what?

Lower neck?

A

Stratified squamous epithelium

Epithelium resembling thyroidal acinar epithelium

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15
Q

Thyroid hormone affects bones how?

A

Stimulates bone resorption leading to osteoporosis and risk of fractures

Atrophy of skeletal m.

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16
Q

What typically presents as a solitary nodule, with amyloid deposits present in the stroma?

Tumor cells (+) for what?

A

Medullary carcinoma

Calcitonin

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17
Q

What cancer has small follicles with colloid w/uniform cells and the nuclei lack the features typical of papillary carcinoma?

What is most important in diagnosing?

A

Follicular carcinoma

Capsular invasion

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18
Q

What % of solitary thyroid nodules are malignant?

Clinical course of these cancers?

A

< 1%

Indolent

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19
Q

Treatment for hyperthyroidism?

A

Beta blocker
thionamide
Iodine
Radioiodine ablation

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20
Q

Hashimoto’s is due to what Pathogenesis?

What mechanisms of cell injury?

A

Breakdown in self tolerance

CD8 - CTL
CD4 - Macrophage
Plasma cell - NK cell (ADCC)

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21
Q

What gene mutation seen in medullary carcinoma?

A

RET

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22
Q

Thyroid parafollicular (C) cells make what?

A

Calcitonin (promotes absorption of calcium by the skeletal system)

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23
Q

What is the most common cause of thyroid pain?

CFs?

Lab values?

A

Granulomatous (De Quervian) thyroditis

Inflammation, hyperthyroidism that lasts 2-6 weeks

High T3, T4
Low TSH
Low radioactive iodine

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24
Q

Peak incidence of PTC?

A

25-50

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25
Q

What genetic defects in thyroid development can cause hypothyroidism?

A

TSH, PAX8, FOXE1

Toilet Paper Fool

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26
Q

Is hypocalcemia seen in sporadic medullary carcinoma?

A

NO

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27
Q

What is an form of extensive fibrosis of the thyroid which mimics thyroid carcinoma?

Related to what?

A

Riddle thyroiditis

Autoimmune IgG4 sclerosing disease

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28
Q

Thyroid adenoma main morphology?

A

Well-defined capsule

Oxyphil or Hurthle cell change

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29
Q

Sporadic goiter occurs in whom? Peaks when?

Caused by what?

A

Females at puberty or young adult

Unknown

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30
Q

Diffusely increased radioactive iodine uptake seen in what?

Increased uptake?

Decreased uptake?

A

Graves

Solitary nodule (toxic adenoma)

Thyroiditis

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31
Q

What is described by an autonomous nodule developing into long-standing goiter and produces hyperthyroidism?

A

Plummer syndrome

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32
Q

What has the morphology of mononuclear inflammatory infiltrate w/well developed germinal centers, loss of thyroid follicles and fibrosis that does not extend beyond the capsule?

Buzz word?

A

Hashimoto’s

Hurthle cell - epithelial cell w/eosinophilic cytoplasm

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33
Q

Clinical course of follicular carcinoma?

What kind of spread?

Prognosis depends on what?

A

Slowly growing painless nodule, “cold” nodule

Vascular (hematogenous)

Extent of invasion and stage

34
Q

What type of thyroid carcinoma occurs in older individuals and portends a worse prognosis?

What mutation are present?

A

Tall-cell variant PTC

BRAF
RET/PTC translocation

35
Q

Diagnose PTC how?

Treat?

Prognosis?

A

Radionuclide scanning - cold nodules and FNA

Total thyroidectomy, chemo, radiation

Excellent but less favorable for pts > 40 y/o

36
Q

What is myxedema?

Basic CFs?

How is cholesterol and LDL affected?

A

Hypothyroidism in older child or adult

Fatigue, apathy, mental sluggishness, Dec CO

Both increased

37
Q

What causes multinodular goiter?

A

Recurrent episodes of hyperplasia and involution

Occur in sporadic and endemic

38
Q

Graves treatment?

A

Beta blocker
Thionamide (PTU)
Surgery/ablation

39
Q

What has lymphocytic infiltration w/large GCs, patchy distribution and collapse of thyroid follicles but NO fibrosis and NO Hurthle cells?

A

Subacute lymphocytic thyroiditis

40
Q

Describe the following labs in Graves:

TSH
T3, T4
Radioiodine

A

Low
High
Increased

41
Q

what are goitrogens?

Suppress what?
What increases?

Examples?

A

Chemical agents that inhibit thyroid gland functions

T3 and T4
TSH

PTU, iodine in large doses

42
Q

What is the incidence of malignancy in long-standing multinodular goiters?

A

Low - 5%

43
Q

90% of pts w/Graves have what?

What polymorphisms may these pts have?

A

TSI (binds TSH receptor and mimics its action)

CTLA4, PTPN22, HLA-DR3

44
Q

Hasimoto’s peak ages and sex?

Autoantibodies to what?

A

Women 45-65

Anti-microsomes
Antithyroid peroxidase
Antithyroglobulin

45
Q

Pts w/Hashimoto’s have increased risk of developing what other autoimmune diseases?

Increased risk of developing what else?

A

T1DM, adrenalitis, SLE, MG, Sjogren

Extranodal Marginal zone B-cell lymphoma

46
Q

What clues tell you a thyroid nodule is more likely benign?

A

Multiple nodules
Older pt
Female
Hot nodule

47
Q

The familial form of medullary carcinoma morphology described how?

A

Bilaterally w/multiple foci

48
Q

What is the most sensitive screening test for hypothyroidism?

Increased or decreased for primary hypothyroidism?

What about T4?

A

Serum TSH level

Increased

T4 decreased

49
Q

What has a nuclear groove, pseudo-inclusions and finely dispersed chromatin making them appear clear or empty?

Buzz word?

A

Papillary carcinoma

Ground-glass or Orphan Annie eye nuclei

50
Q

Diffuse nontoxic (simple) goiter TSH level?

T3, T4?

Therefore they are mostly what?

A

Elevated

Normal

Euthyroid

51
Q

What has uni or bilaterally enlarged and firm thyroid, multinucleate giant cells around colloid?

A

De Quervian (granulomatous))

52
Q

What drugs can cause hypothyroidism?

A

Lithium
Iodines
P-aminosalicylic acid

53
Q

What causes an uneven radioiodine uptake and sometimes a “hot” nodule from an admixture of hyperplastic and involuting nodules?

What can be helpful in diagnosing it?

A

Multinodular goiter

FNA

54
Q

What is the thyrotoxicosis?

A

Hypermetabolic state caused by elevated circulating levels of free T3 and T4, most commonly due to hyperthyroidism

55
Q

Where is endemic goiter common?

Pathogenesis?

A

Low levels of iodine - Andes and Himalayas

No iodine -> dec synthesis of thyroid hormone -> inc TSH -> follicular cell hypertrophy and hyperplasia -> goiter gets big

56
Q

What presents as a unilateral painless mass discovered during routine physical, is nonfunctional in general, with uniform and bland cells?

A

Thyroid adenoma

57
Q

CF of Hashimoto’s?

Lab findings in hasitoxicosis?

A

Painless enlargement of thyroid, symmetric and diffuse

Free T3 and T4 INC
TSH Dec
Radioactive iodine Dec

58
Q

How do you 1st diagnose a thyroid adenoma?

Then what?

Ultimately need to do what?

A

Radionuclide scan, cold nodules take up less radioactive iodine

US and FNA

Surgically resect to examine capsule

59
Q

An isolated cervical nodal metastasis in PTC has what influence on prognosis?

A

NONE

60
Q

Which medullary carcinomas are generally more aggressive?

What action to take?

A

MEN-2B

Prophylactic thyroidectomy

61
Q

3 main CF of multinodular goiter?

A

Mass effects then

Cosmetic
Airway obstruction and dysphagia
SVC syndrome

62
Q

30% of medullary carcinomas are familial due to what?

A

MEN 2A or 2B

Familial medullary TC

63
Q

What binds T3 and T4?

How is T4 converted to T3?

A

TBG and transthyretin

deiodinated in periphery

64
Q

Prognosis of encapsulated follicular variant of PTC?

Mutation in what?

What kind of architecture does it have?

A

Favorable

RAS

Follicular

65
Q

Medullary carcinomas are derived from what?

Secrete what?

What else may they secrete?

A

C cells

Calcitonin

Serotonin, ACTH, VIP

66
Q

What condition may produce an audible bruit over the thyroid gland?

Pts at risk for what else?

A

Graves

SLE, Pernicious anemia, Addison’s, DM

DAPS

67
Q

Treatment for follicular carcinoma?

A

Total thyroidectomy followed by radioactive iodine

Thyroid hormone as well

68
Q

Thyroid storm is what?

Occurs in whom?

Results from what?

CFs?

A

Abrupt onset of severe hyperthyroidism

Pts w/underlying Graves

Acute elevation in catecholamines from any stress

Febrile, tachycardia –> medical emergency due to cardiac arrhythmia

69
Q

What structure in the eye expresses the TSH receptor?

A

Orbital preadipocyte fibroblasts

70
Q

What is monitored after tx of follicular carcinoma?

A

Serum thyroglobulin

71
Q

Thyroid hormone resistance syndrome caused by what?

Leads to what?

A

THRB mutation

Hypothyroidism

72
Q

What is hypothyroidism in infancy or early childhood called?

Found where?

CFs?

A

Cretinism

Dietary iodine deficiency endemic –> Himalaya, China, Africa

Mental retardation, short stature, coarse facial features, protruding tongue, umbilical hernia (5 total)

73
Q

Follicular carcinoma more common in whom?

Peak incidence?

A

Women

40-60 y/o

74
Q

What presents as a rapidly enlarging bulky neck mass w/symptoms related to compression of adjacent structures?

A

Anaplastic carcinoma

75
Q

What are the types of thyroid carcinomas?

A 
PFAM
Papillary - 85%
Follicular 5-15%
Anaplastic
Medullary from C cells and NOT follicular epithelium
76
Q

How does hyperthyroidism affect the gut?

A

Hyperstimulates it causing diarrhea and malabsorption

77
Q

What converts thyroglobulin to T3 and T4 (thyroxine)?

Which is more potent?

A

Follicular cells

T3

78
Q

What is described by pale colloid w/scalloped margins, lacking fibrovascular cores, and diffuse hypertrophy and hyperplasia of thyroid follicular epithelial cells?

A

Graves

79
Q

Who and when get thyroid carcinomas?

What gives an increased risk?

A

Women in early and middle adult years

Ionizing radiation early in life –> papillary carcinoma

Iodine deficiency –> follicular carcinoma

80
Q

What shows giant cells, spindle cells, mixed cells and is (+) for cytokeratin on morphologic exam?

A

Anaplastic carcinoma

81
Q

What mutation in papillary carcinoma is an adverse prognostic factor?

A

BRAF

Endocrine II AH (6 decks)

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