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endo II exam1 > Thyroid part II > Flashcards

Thyroid part II Flashcards

1
Q

What are first signs subacute lymphocytic thyroiditis

A

mild hyperthyroidis,, goitrous enlargement of gland

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2
Q

demographics subacute lymphocytic thyroiditis

A

middle aged adults more common in women

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3
Q

postpartum thyroiditis and subacute lymphcytic (painless) thyroiditis are subtypes of what

A

autoimmune thyroiditis

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4
Q

must look into what with patient with painless thyroiditis

A

family history for autoimmune disorders

and look for antithyroid peroxidase Ab

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5
Q

what is difference morpho of hashimoto and painless thyroditis

A

no fibrosis or hurthle cell metaplasia in painless thyroiditis

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6
Q

progression of painless thyroiditis over 10 years

A

progress to hypothyroidism

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7
Q

what cna trigger granulomatous thyroiditis

A

viral infeciton, usually URI

coxsackie, mumps, measles, adenoa and other viral infections

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8
Q

describe radioactive iodine uptake in granulomaotus thyroidits

A

iodine uptake is diminished even though high T3 T4 and low TSH

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9
Q

extensive fibrosis of thyroid and contiguous neck structures

A

riedel thyroiditis

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10
Q

riedel thyroiditis is assoc with what

A

systemic autoimmune IgG4 disease

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11
Q

start at

A

thyroid neoplasm

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12
Q

what is the most common cause of impaired synthesis of thyroid hormone

A

dietary iodine deficiency

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13
Q

what occurs with impaired synthesis of thyroid hormone

A

goiter, enlargement of thyroid

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14
Q

what is a diffuse nontoxic goiter

A

enlargement without producing nodularity

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15
Q

where are areas of endemic goiters

A

in the mountains, low levels iodine

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16
Q

what food interfere with thyroid hormone synthesis

A

cabbage, cauliflower, brussel sprouts, turnips and cassava

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17
Q

sporadic goiters are more common in who

A

young females at puberty or young adult life

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18
Q

how does impairment of thyroid hormone synthesis lead to large thyroid

A

compensatory rise in TSH which causes hypertrophy and hyperplasia

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19
Q

what are the phases of diffuse nontoxic goiter

A

hyperplastic phase and phase of colloid involution

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20
Q

histo characteristics of colloid goiter

A

thyroid is brown and translucent, follicular epithelium is flattened cuboidal and colloid abundant

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21
Q

clincal Sx nontoxic/simple goiter

A

mass effects from enlarged gland

22
Q

T3T4TSH levels in simple goiter

A

T3 T4 normal

TSH high normal

23
Q

recurrent episodes of hyperplasia of the thyroid can lead to what

A

multinodular goiter

24
Q

what is an intrathoracic or plunging goiter

A

when the thyroid grows behind the sternum

25
Q

microscopic appearance of colloid rich follicles with inactive epithelium and areas of follicular hyperplasia

A

multinodular goiter

26
Q

how to distinguish multinodular goiter from follicular neoplasm

A

absence of prominent capsule that is present in follicular neoplasm

27
Q

what can a large multinodular goiter lead to

A

airway obstruction, dysphagia and compression of large vessels in neck and upper thorax (superior vena cava syndrome)

28
Q

What is Plummer syndrome

A

toxic multinodular goiter when it starts to produce hyperthyroidism

29
Q

radioiodine scan of a toxic multinodular goiter

A

uneven iodine uptake

30
Q

what is a solitary thyroid nodule

A

palpable discrete swelling within an otherwise apparently normal gland

31
Q

what is the concern for a person with a thyroid nodule

A

possibility of malignant neoplasm

majority benign10:1

32
Q

what thyroid nodules are more likely to be neoplastic

A

solitary, nodules in younger patients
nodules in males
history of radiation

33
Q

hot nodules (take up lots of iodine) are more likely to be benign or malignant?

A

benign

34
Q

US can tell you what about thyroid mass

A

solid or cystic

35
Q

most thyroid adenomas are what

A

follicular adenomas because derived from follicular epithelium

36
Q

what is a toxic adenoma

A

an adenoma that produces thyroid hormones–> thyrotoxicosis

hormone production without stimulation

37
Q

morphology follicular adenoma

A

solitary, encapsulated lesion demarcated by intact capsule
average 3 cm diameter
gray-white to red brown
areas of hemorrhage, fibrosis calcification and cystic changes

38
Q

difference of follicular adenoma from carcinoma

A

carcinoma invades BM

39
Q

Hurthle cell change

A

adenoma

lots of mitochondria, Tx aggressively

40
Q

nonfunctioning adenomas appear how on radionucleotide scan

A

cold nodules

41
Q

how is Dx made of thyroid adenoma

A

histologic examination of capsular integrity

42
Q

Common types of thyroid carcinomas

A

papillary– majority!!
follicular
anaplastic (undifferentiated)
medullary

43
Q

majority papillary carcinomas have what mutation

A

point mutation in BRAF signaling

some have RET translocation or inversion

44
Q

follicular and anaplastic carcinomas have what mutations

A

RAS point mutation
PI3K point or amplification mutation
PTEN point mutations

45
Q

majoirty of thyroid carcinomas are what

A

papillary

46
Q

gray/white tumor

A

papillary carcinoma till proven otherwise

47
Q

orphan annie nuclei (optically clear nuclei)

A

papillary carcinoma

48
Q

psamomma bodies

A

papillary carcinoma
ovarian cancer
craniopharyngioma

49
Q

patient with mass in cervical lymph node, otherwise asymptomatic

A

papillary carcinoma, isolated cervical mets no significance on prognosis

50
Q

good test for distinguishing benign and malignant papillary carcinomas

A

fine needle aspiration

51
Q

prognosis of papillary thyroid cancer

A

excellent

depends on age and distant mets

endo II exam1 (14 decks)

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