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ENRP > Thyroid Path > Flashcards

Thyroid Path Flashcards

1
Q

elderly adult with unexplained weight loss and cardiovascular disease may have

A

apathetic hyperthyroidism

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2
Q

name the components of the burch-wartofsky score

A
  1. fever
  2. cardiac (tachy, CHF)
  3. GI (jaundice, diarrhea)
  4. precipitating history (pregnancy/postpartum, hemithyroidectomy, amiodarone)
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3
Q

describe the treatment of thyroid strom

A
  1. PTU
  2. B-blockers
  3. steroids
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4
Q

why is PTU used in the treatment of thyroid storm?

A

inhibits:

  1. peroxidase
  2. peripheral conversion of T4 —> T3
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5
Q

pt presents with arrhythmia, fever, vomiting and hypovolemic shock, consider…

A

thyroid storm

“tachycardia will be out of proportion to fever”

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6
Q
  1. hyperthyroidism with gland enlargement
  2. infiltrative opthalmopathy
  3. pretibial myxedema
A

grave’s disease

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7
Q

scalloping

A

grave’s disease

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8
Q

T3/T4: high
TSH: low
TSI: high

A

grave’s disease

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9
Q

describe the pathogenesis of pretibial myxedema and exophthalmos in graves disease

A

fibroblasts express TSH receptor

activation –> glycosaminoglycan (chondroitin sulfate and hyaluronic acid) buildup, inflammation, fibrosis, and edema

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10
Q

what type of hypersensitivity reaction is grave’s disease?

A

TIIHSN

IgG autoAb stimulate TSH receptor; MC AB is TSI

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11
Q

what changes are responsible for the increase in BMR in hyperthyroidism?

A

increased synthesis Na-K ATPase

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12
Q

what changes are responsible for the increase in sympathetic activity in hyperthryroidism?

A

increased expression B1-adrenergic receptor

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13
Q

describe the presentation of cretinism

A
  • growth and mental retardation
  • coarse facial features
  • umbilical hernia
  • enlarged tongue
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14
Q

one cause of cretinism is dyshormonogenetic goiter, which is due to…

A

congenital defect in thyroid hormone production – most commonly involving thyroid peroxidase

other causes: thyroid agenesis, maternal hypothyroidism

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15
Q

thyroglossal duct cyst presents as

A

anterior neck mass

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16
Q

lingual thyroid presents as

A

base of tongue mass

this is persistence of thyroid tissue at the base of the tongue

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17
Q

multinodular goiter is due to

A

iodine deficiency

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18
Q

how is cassava root a goitrogen?

A

a thiocyanate; inhibits iodide transport in thyroid

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19
Q

how does a toxic goiter develop?

A

regions of a multinodular goiter become TSH-independent —> release T4 —> hyperthyroidism

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20
Q

what age group is affected by myxedema?

A

older children and adults

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21
Q

is hyperglycemia seen in hyper or hypothyroidism?

explain why

A

hyperthyroidism

TH causes gluconeogenesis and glycogenolysis effects

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22
Q

is hypercholesterolemia seen in hyper or hypothyroidism?

A

hypothyroidism

note: cardiac output is decreased, bradycardia

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23
Q

in hypothyroidism, this results in a deepening of the voice and large tongue

A

myxedema

pts also have cold intolerance, weight gain, and mental and physical slowing

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24
Q

what are the most common causes of myxedema?

A

iodine deficiency and Hashimoto thyroiditis

also: lithium; surgical removal or ablation of thyroid

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25
Q

Hashimoto thyroiditis is associated with HLA…

A

DR5

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26
Q

initially Hashimoto may present as hyperthyroidism, why?

A

follicle damage – release of hormones

aka Hashitoxicosis

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27
Q

Hashimoto will progress to presenting with…

A

hypothyroidism; low T4 & elevated TSH

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28
Q

Hashimoto has autoAbs against…

A

thyroglobulin (Tg) & thyroid peroxidase (TPO)

possibly: anti-microsomal

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29
Q

histology:

chronic inflammation (lymphocytic infiltrate) with germinal centers & Hurthle cells (eosinophilic metaplasia of cells lining the follicles)

A

Hashimoto thyroiditis

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30
Q

Hashimoto thyroiditis results in increased risk for

A

B-cell (marginal zone) lymphoma

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31
Q

enlarging thyroid gland late in Hashimoto thyroiditis disease course is concerning for

A

B-cell (marginal zone) lymphoma

32
Q

name the four euthyroid diseases

A
  1. granulomatous (+)
  2. subacute (-)
  3. Riedel*
  4. neoplasms

*really, only hypothyroid (-)

33
Q

transient period of thyroid hormone irregularities (usually hypo), +/- goiter, painless

A

subacute lymphocytic thyroiditis

ex: postpartum thyroiditis

34
Q

this thyroiditis is painful, tender; possibly viral in origin

(usually hyper)

A

subacute granulomatous (de Quervian) thyroiditis

35
Q

subacute granulomatous (de Q) thyroiditis is associated with HLA…

A

B35

36
Q

a young patient with a hard as wood and nontender thyroid…

A

riedel fibrosing thyroiditis

37
Q

riedel fibrosis may extend to involve

A

local structures, such as the airway

38
Q

how can you differentiate between riedel fibrosing thyroiditis and anaplastic carcinoma?

A

patient’s with riedel are younger (40s)

39
Q

a thyroid that is very pale after excision likely had what disease process?

A

riedel fibrosing thyroiditis

40
Q

which thyroiditis is considered an IgG-4 related disease?

A

riedel fibrosing thyroiditis

will show fibrosis (duh), lymphocytes, and plasma cells

41
Q

what cells secrete IL-10 and TGF-B to induce IgG4 production and fibrosis?

A

Treg

IL-10 —> B cells & plasma cells
TGF-B —> fibroblasts

42
Q

what are the three more common IgG-4 related diseases?

A
  1. autoimmune pancreatitis
  2. sclerosing mediastinitis
  3. idiopathic retroperitoneal fibrosis
43
Q

name the mass effect symptoms of a goiter

A
  1. dysphagia
  2. hoarseness
  3. stridor
  4. SVC syndrome
44
Q

thyroid scintigraphy isn’t great for determining malignancy but between hot and cold, which is more likely to be malignant?

A

cold

45
Q

on uptake, graves disease and nodular goiter are usually

A

hot

46
Q

on uptake, adenoma and carcinoma are usually

A

cold

47
Q

benign proliferation of follicles surrounded by a fibrous capsule

A

follicular adenoma

48
Q

what age group is papillary thyroid carcinoma seen in?

A

25-50

49
Q

what is the most common type of thyroid carcinoma?

A

papillary carcinoma (80%)

good prognosis (10 yr survival >95%)

50
Q

what is a major risk factor for papillary thyroid carcinoma?

A

exposure to radiation in childhood (chernobyl)

51
Q

histology:

papillae lined by cells with clear “orphan annie eye” nuclei and nuclear grooves; psammoma bodies

A

papillary thyroid carcinoma

52
Q

where does papillary thyroid carcinoma spread?

A

cervical LNs

53
Q

how does papillary thyroid carcinoma present?

A

it is usually asymptomatic; palpable nodule or ultrasound possible

54
Q

age is a significant factor in the staging of

A

thyroid carcinoma

55
Q

RET-PTC & BRAF mutations

A

papillary thyroid carcinoma

56
Q

what papillary thyroid carcinoma variant has RAS mutations?

A

follicular variant

*RAS mutations are not specific though

57
Q

what papillary thyroid carcinoma variant is seen in elderly patients? it is aggressive

A

tall cell variant

58
Q

what papillary thyroid carcinoma variant is seen in kids and young adults?

where does it mets?

A

diffuse sclerosing variant

lung, brain, bone and liver

  • this variant has the tendency to recur and is aggressive, but has a good prognosis
59
Q

RAS and PTEN mutations are seen in the follicular carcinoma, however this is not specific. which mutation is specific?

A

PAX8/PPARG fusion gene

recall RAS is also seen in follicular variant of papillary thyroid carcinoma

60
Q

what two types of invasion are seen in follicular carcinoma?

A

mushroom invasion (of the capsule) & angioinvasion

61
Q

how does follicular carcinoma of the thyroid mets?

A

hematogenously (b/c of angioinvasion)

62
Q

a rapidly enlarging, bulky neck mass in a pt 65+ with dysphagia and respiratory compromise is concerning for

A

anaplastic carcinoma of the thyroid

63
Q

histology:

orphan annie eye nuclei
speckled necrosis
large cells

A

anaplastic carcinoma

an undifferentiated malignant tumor

64
Q

constitutive tyrosine kinase activity in papillary carcinoma is due to what mutation?

A

RET/PTC

65
Q

MAP kinase signaling in papillary carcinoma is due to what mutation?

A

BRAF

66
Q

what thyroid carcinoma has TP53 mutations?

A

anaplastic

67
Q

histology:
cells are larger and have more cytoplasm

what is their secretory product?

A

parafollicular c cells of the parathyroid gland – they secrete calcitonin

68
Q

histology:

blue cells with dispersed chromatin; salt and pepper
amyloid
sheets of neuroendocrine cells
c-cell hyperplasia

A

medullary carcinoma

69
Q

calcitonin lowers serum calcium by…

A

increasing renal excretion of calcium

70
Q

familial or sporadic medullary carcinoma?

50; unifocal, aggressive

A

sporadic

70-80% of medullary thyroid carcinomas

71
Q

familial or sporadic medullary carcinoma?

43; multifocal, best prognosis

A

familial

72
Q

familial cases of MTC are often due to…

A

MEN 2A and 2B

73
Q

what mutation warrants prophylactic thyroidectomy?

A

RET – familial MTC/MEN

74
Q

describe how a pt with MTC could present with hypocalcemia

A

tumor produces high levels of calcitonin

*monitor calcitonin for progress of the tumor

75
Q

parathyroid hyperplasia, pheochromocytoma; MTC

normal body habitus

A

MEN 2A

“2 Ps)

76
Q

pheochromocytoma, oral and intestinal ganglioneromatosis; MTC

marfanoid body habitus

A

MEN 2B

“1 P”

ENRP (6 decks)

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