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Pathology 2-Systemic > Thyroid & Parathyroid > Flashcards

Thyroid & Parathyroid Flashcards

1
Q

Thyrotoxicosis

A
  • Increased free T4/T3 w/low TSH causes symptoms:
  • GIT=Mal-absorption <strong>(diarrhea)</strong>
  • <em><strong>Constitutional</strong></em>=Heat intolerances, weight loss, sweating
  • Cardiac=Palpitation, Tachycardia, A Fib <strong>(increase Beta adrogenergic receptors)</strong>
  • Thyroid myopathy <strong>(Proximal muscle weakness)</strong>
  • Tremor
  • Staring gaze & Lid lag
  • Hyperparathyroidism (increase in I131 uptake):
  • Graves (Auto-Ab)
  • Toxic multinodular goiter (Plummer’s disease)
  • Toxic adenoma <u>(decreased </u>uptake of I 131)
  • Transient thyroiditis
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2
Q

Graves Disease

A
  • Age 20-40 Autoimmune condition (female common)
  • Associated w/Human leukocyte Ag (HLA-DR3)
    • SLE & pernicous anemia <strong>(loss of parietal cells)</strong>
  • Due to Anti-TSH receptor Ab
    • Thyroid stimulating Immunoglobulin <strong>(TSI)</strong>
    • Thyroid growth stimulating Immunoglobulin<strong> (TGI)</strong>
    • TSH receptor binding inhibitor immunoglobulin <strong>(TBIIS)</strong>
  • Diffuse symmertric hyperplasias of gland
  • Histo: Follicle lined by tall columnar cells, Papillary projections w/<u>scalloped appearance</u>
  • Low TSH w/HIGH free T4-Diffuse increased I 131 uptake
  • Symptoms:
  • Opthalamopathy-exopthalmus (eye popping)
    • Can be present even after accumulation of fat & immune cells behind eye
  • Dermopathy-Peritibial myxedema (doughy skin)
  • Thyroid storm-Brought on by stress (shock)
  • Treat: Beta blockers & Thiomide (No free T3/T4 made peroxidase blocker)
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3
Q

Secondary Hyperthyroidism

A
  • Primary reason Pit adenoma
  • TSH normal or **Elevated **
  • Free T3 & T4 VERY high
  • No increase in I 131 uptake
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4
Q

Hypothyroidism-General

A
  • Child = **Cretinism (Low T4) **
  • Adult = Primary (thyroid) & Secondary (Hypopit)
    • <u><strong>Secondary-</strong></u>Low Free T4/T3 w/Low TSH
    • <u><strong>Secondary-</strong></u>Hypothalamic failure or Pit necrosis <strong>(Sheehan’s)</strong>
  • Primary: Autoimmune or NON-autoimmune Thyroiditis
  • LOW free T4/T3 w/very HIGH TSH
  • Categories:
  • <strong>No goiter </strong>= idiopathic <u>(most common in US)</u>
  • Iodine def <u>(sub-himalayan Asia)</u> w/Goiter
  • Cretinism + Goiter-<u>Umbilical hernia, protruded tongue, impaired development</u>
  • <em><strong>Hashimoto’s thyroiditis </strong></em>+ Goiter
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5
Q

Hypo/Hyper thyroidism-Myxedema

A
  • Associated w/Severe-long standing Hypothryroidism
  • Accumulation of mucopolysacs <strong>(proteoglycans) </strong>in Subcut tissue
  • Also seen in Graves-Eyes & Tibia
  • Symptoms:
  • Mental obtundation (not alert)
  • Mortality is over 50%
  • Bradycardia & Hypotension present
  • Hypothermia
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6
Q

Primary Hypothyroidism (Autoimmune)

A
  • TSH Very high <strong>(greater 10)</strong> & free T3, T4 LOW
  • Brief period of increased T3/4 = **Hashitoxocosis **
    • Release of thyroxin from damaged follicles
  • High cholesterol & TAG lvls w/chance of coronary atherosclerosis & reduced cardiac output
  • Hashimoto’s Thyroiditis:
  • Age 45-65 common female
  • PAINLESS diffuse symmetrical enlargement of gland
  • Histo: Hurthle cells (Eosinophilic-Degenerated follicular-altered Mitochondria)
  • Assoc w/HLA DR3 & DR5 (SLE, RA, Sjogren’s)
  • Increased risk of non-Hodgkin’s lymphoma
    • due to chornic inflammation of <u>germinal centers</u> <u>(B-cell-marginal cell lymph)</u>
    • Diffuse infiltrate of lymphoid cells<u>-CD8/4</u>
  • Antibodies are-marker for thyroid damage:
  • Antithyroglobulin
  • Antimicrosomal <u>(<strong>thyroid peroxidase</strong>-liberates iodine to thyroglobulin make T3/4)</u>
  • Anti-TSH receptor Ab <strong><u>(inhibitory)</u></strong>
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7
Q

Subacute Granulomatous Thyroiditis

A
  • “De quervain’s disease”-Does not progress to Hypothyroidism
  • Post-Viral infection-Female 30-50
    • <strong>Coxsackie, mumps, adenovirus</strong>
  • Tender firm enlarged gland-“Painful”
  • Transient thyrotoxicity in progression later normalizes
    • Increased WBC & ESR
  • Self-limiting w/in 6-8 weeks
  • Histo: large foreign body giant cells & granuloma w/inflammatory destruction of follicles
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8
Q

Riedel Thyroiditis

A
  • Chronic form of thyroiditis-Hypothyroidism
  • Dense fibrosis in thyroid & can spread to trachea/esophagus
    • Mimics carcinoma-<em><u>Anoplastic unidffer </u>disease of elderly</em>
  • Symptoms-Young women:
  • Stridor, dyspnea, dysphagia
  • “Hard as wood”
  • Associations:
  • Retroperitoneal & severe mediastinal fibrosis
    • Idiopathic pulm fibrosis/scleroderma-ANAs
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9
Q

Thyroid Cyst

A
  • Thyroglossal duct cyst: Midline ant neck
    • Move up & down w/swallowing
    • Below hyoid bone
    • Remnant of thyroglossal duct
    • Atrophic thyroid tissue found
  • Branchial (cleft) cyst: Lateral neck
  • Smooth, nontender, fluctuant masses
  • Cong epi cysts
    • Lined by ciliated columnar epi <strong>(resp & lymph)</strong>
    • Squamous epi & lymph w/germinal follicle=<strong>Thyroglossal cyst</strong>
  • Failure of obliteration of second branchial cleft
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10
Q

Goiter (Diffuse non-toxic)

A
  • Goiter: Diffuse enlargement of thyroid
  • Prolonged iodine def (Euthyroid)
  • Colloid goiter (single nodule) & Multi nodular (MNG)
  • Normal free T4 w/slight increase in TSH
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11
Q

Goiter (Multinodular)

A
  • Non-toxic & Euthyroid (normal function)
  • Complication:
  • Plummer Syndrome: Nodules become toxic (make T4) develops hyperthyroidism
  • Multi-focal I131 uptake (scattered)
  • Can progress to Follicular carcinoma
  • Morphology: Enlarged thyroid gland w/multiple colloid nodules (Tend NOT to spread)
  • Histo: Follicles vary in size w/clacification & fibrosis
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12
Q

Thyroid adenoma (follicular)

A
  • Cold - Thyroid = Taking up LESS I 131
  • Indicative of Adenoma OR Carcinoma
  • Follicular adenoma:
  • Single encapsulated & firm
  • RARE can produce T4 (HOT) toxic adenoma (single area)
  • Well formed capsule = Well circumscribed nodule
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13
Q

Thyroid Carcinoma (Papillary)

A
  • Most Common-Assoc w/neck radiation in early life
  • Genetics-Rearrangements=tyrosine kinase receptors (RET)
  • Spreads to lymphatics-regional (cervical)=<u><strong>Good prognosis</strong></u>
  • Clinical-PAINLESS mass in ant neck
  • Histo:
  • Psammoma body (“orphan Anny”) Swirl collection of Ca+2
  • Intranuclear pseudo inclusion bodies
  • Papillary structure-Optically clear hypochromatic nucleus
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14
Q

Thyroid Carcinoma (Follicular)

A
  • Mostly Cold & rare Hot
  • Males more affected (40-60)
  • Genetics: Mutation HRAS, NRAS, KRAS
  • Hematogenous (blood) travels to bone/lung=BAD prognosis
    • Renal cell, Hepato, Chorio
  • Histo: Vascular invasion of capsule
  • Invasion mediated by-
  • laminin receptor in tumor
  • production of Cathepsin D
  • Collagenase 4
  • Proteases
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15
Q

Thyroid Carcinoma (medullary)

A
  • Parafollicular C-cell<strong> (neuroendocrine)</strong>-Malignant
  • Produces Calcitonin <strong>(Hypocalcemia-counters PTH)</strong>
  • Association with MEN 2a/2b in older pt:
  • MEN2a-Medullary Carcinoma + hyperparathyroid + pheochromocytoma
  • MEN2b-Medullary Carcinoma + Pheochromocytoma + Neuroma of GIT
    • RET gene mutation in Young pt
  • Symptoms: Flushing, diarrhea, itching
  • Morphology: “Multicentric”
  • Histo: Spindle cells**+Pink **amyloid stroma
    • <strong>(calcitonin deposits as amyloid)</strong>
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16
Q

Primary/Tertiary Hyperparathyroidism

A
  • Symptoms from High (ionized) Ca+2
  • Assoc with Cancer metases-Breast, lung, kidney
  • Nephrocalcinosis (metastatic calcification):
    • Peptic ulcer
    • acute pancreatitis<strong> (activate enzymes)</strong>
    • Gall stones (calcium oxalate)
  • High Serum PTH, Ca+2, Alkaline phosphotase (osteoblast)
  • Famous 4- Painful bones, Renal stones, Abdominal groans, Psychic moans
  • Linked to depression
17
Q

Primary Hyperparathyroidism

A
  • Chief cells-Regulate free ionized Ca+2 via PTH
  • Adenoma of parathyroid-Benign
  • Disease of adults-common in women
  • Associated with MEN 1 <strong>(3 p’s pancreas, pit, PT)</strong>
  • Involves **single gland-Capsulated **
  • Increase in urine phosphate & ca+2
  • Symptoms (increase in PTH):
  • Hypercalcemia=Metastatic calcification <u><strong>(acute pancreaitis)</strong></u>
  • Fibrosis of bone <strong>(Osteitis fibrosa cystica)</strong>
  • Increase in urinary cAMP (PTH-GS-Adenyl cyclase)
  • Increase in alkaline phosphatase (due activation of osteoblast)
  • Calcium oxalate stone (kidney)
18
Q

Secondary Hyperparathyroidism

A
  • Common assoc w/chronic renal failure
    • Other assoc-Malabsorption/Vit D def
    • Linked to <u>Autosomal dominant Polcystic Kidney</u>
  • Loss of renal function-Reduces alfa-1-hydroxylase for Vit D
    • Reduced Ca+2 absorption from gut <strong>++increase to PTH</strong>
  • High Phosphate, PTH, Alkaline phosphatase
  • Hypocalcemia (<strong>l</strong><strong>ow ca+2 due to phosphate binding)</strong>
  • Imparied phosphate secretion=Reduction of Ca+2
  • Low Ca+2 = Stimulation of PTH <u><strong>(constant stim=Hyperplasia)</strong></u>
  • Ca+2 lvls normalize due to osteoblast/Osteoclast activity on bone decreases density <u><strong>(osteopenia) </strong></u>
  • Ca+2 lvls become low again due to CRF
19
Q

Osteitis Fibrosa Cystica (2nd Hyperparathyroidism)

A
  • Diffuse bone loss (sub-periosteal thinning & bone cyst formation)
  • Due to osteoclastic resorption & fibrous replacement of bone
  • X-ray: Multiple lytic lesions/fractures
  • Location-
  • Small bones (phalanges)
  • Skull & vertabrae
  • Shaft of long bones
  • Histo: Brown tumor deposition of hemosiderin & giant cell formation
20
Q

DiGeorge Syndrome

A
  • CATCH 22
  • Cardian defects-Prolonged QT interval
  • Abnormal face-Tetany (muscle spasm facial nerve)
  • Thymic hypoplasia
  • Cleft palate-<u><strong>Dental abnormality</strong></u>
  • Hypocalcemia-+Chvostek’s sign hyperexcitable
  • Genetics- 22q11 deletion (failure of 3rd/4th pharyngel pouch)
  • Symptoms:
  • Immune Def.
  • Cataracts
    • for Trousseau’s sign = venous thrombosis
21
Q

Pseudo-Hypoparathyroidism

A
  • Albright’s Hereditary osteodystrophy-
  • Lack of response to PTH
  • PTH-resistant hypocalcemia (TSH & LH/FSH also)
  • Due to defective G-coupled Stim alpha subunit
  • Symptoms:
  • Short stature, round face, Short FOURTH metacarpal
  • Test:
  • Low Ca+2
  • Increase in phosphate
  • Increase in INTACT PTH (receptor resistance)
  • Low urine cAMP w/PTH stimulation

Pathology 2-Systemic (15 decks)

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