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HRM Test 1 > Thyroid Path- Krafts > Flashcards

Thyroid Path- Krafts Flashcards

1
Q

Low TSH

Low T4

A

Secondary Hypothyroidism

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2
Q

High TSH

Low T4

A

Primary Hypothyroidism

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3
Q

Low TSH

High T4

A

Primary Hyperthyroidism

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4
Q

High TST

High T4

A

Secondary (or tertiary) hyperthyroidism

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5
Q

A little variation in T4 can cause a ______ fluctuation in TSH

A

LARGE

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6
Q

What are the 3 anti-thyroid antibodies you should check for?

A

Anti-peroxidase (anti-microsomal)
Anti-thyrogolobulin
Anti-TSH-receptor

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7
Q

What are you looking for when doing the radioiodine thryoid scanning?

A

Looking at iodine uptake

A lot of uptake = hot
Less active = cold (10% malignant)

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8
Q 
Arrhythmias
Tremor
Lid Lag & wide staring gaze
Warm, moist, flushed skin
Diarrhea

Suggests……

A

HYPERthyroidism

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9
Q 
Delayed reflexes
Myxedema
Slow pulse
Constipation
Dry, pale skin

Suggests….

A

HYPOthyroidism

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10
Q

What is cretinism?

A

Congenital Hypothyroidism

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11
Q

Which auto-antibody is most specific for Hashimotos?

A

Anti-peroxidase

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12
Q

Why is there transient hyperthyroidism in Hashimotos?

A

As follicles are destroyed some colloid leaks out

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13
Q

45 year old female:
Non-painful enlarged thyroid
Weight gain
Hyporeflexive

Lab Tests:
+ anti-peroxidase
+anti-TSH-receptor

FNA:
Hurthle Cells
Many germinal centers

A

Hashimotos

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14
Q

What thyroiditis is associated with a recent viral upper respiratory infection?

A

DeQuervain Thyroiditis (aka subacute or granulomatous)

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15
Q

30 year old male
Flu-like syptoms
Throat pain radiating to ear
Enlarged thyroid

A

DeQuervain Thyroiditis

*usually self-limiting, no need to treat!

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16
Q

In which thyroiditis would you see multinucleate giant cells?

A

DeQuervain Thyroiditis (aka granulomatous thryoiditis!!)

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17
Q

3 months after pregnancy
Enlarged painless thyroid
Otherwise asymptomatic

Histology:
Lymphocytes but no germinal centers, plasma cells, or Hurthle cells

A

Silent Thyroiditis

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18
Q

Rock-hard, “woody” neck mass?

A

Reidel’s Thyroiditis

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19
Q

What is Reidel’s Thyroiditis?

A

Fibroblast proliferate and lay down collagen

Patients may have other glands involved

Hypothyroidism

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20
Q

What is myxedema?

A

Accumulation of hydrophilic ground substance (glycosaminoglycans) through the connective tissues in the body

Leads to:
non-pitting edema
Coarsening of facial features
Enlargement of tongue
Deepening of voice
21
Q

Do you myxedema with hyper or hypo-thyroidism?

A

Hypothyroidism!

22
Q

What is Grave’s disease?

A

Autoimmune

Ab stimulates TSH receptor

23
Q

What is the triad for Grave’s Disease?

A
  1. Hyperthyroidism
  2. Opthalmopathy (lid lag + exopthalmos)
  3. Dermopathy (pretibial myxedema)
24
Q

On histology if you saw crowed follicular epithelial cells form that form papillae and scalloped borders, what would you think?

A

Grave’s Disease

25
Q

What would you use to treat grave’s disease?

A

B-blocker for symptoms

Propylthiouracil to decrease thyroid hormone synthesis

26
Q

Describe the process of goiter developmenet

A

Thyroid makes less thyroid hormone

TSH level goes up

Thyroid grows bigger

27
Q

What is the first stage of goiter formation?

A

Simple goiter = diffuse nontoxic goiter, colloid goiter

28
Q

Do simple goiter’s have nodules?

A

NO!

29
Q

Describe a multinodular goiter

A

Second stage - developes pre existing goiter

Thyroid is huge and nodular

30
Q

What causes a goiter?

A

Excessive TSH stimulation

Can be due to

  • lack of iodine
  • ingestion of substance that interfere with thyroid hormone synthesis
  • Hereditary enzyme defects

**can be hyper, hypo, or euthyroid

31
Q

What is Jod-Basedow Phenomenon?

A

When a patient has a goiter (due to idodide deficiency)

A small amount of iodide is given to the patient (maybe for imaging)

But thryoid is under HEAVY TSH hormone stimulation

Acute hyperthyroidism and even hyperthyroid crisis can occur - thyrotoxicosis

32
Q

How should you biopsy the thyroid?

A

Fine Needle Aspiration

33
Q

Follicular Adenoma

A

Benign proliferation of follicules surrounded by a fibrious capsule

34
Q

Why should you also surgically remove a follicular adenoma even though it is benign?

A

Hard to distinguish from Follicular adenocarcinoma = malignant

35
Q

Most common thyroid malignancy?

A

Papillary Carcinoma

36
Q

Orphan Annie Eye Nuclei

A

Papillary Carcinoma

Empty-appearing nuclei w/ central clearing

37
Q

Nuclear Grooves

A

Papillary Carcinoma

Line/Groove with in the nucleus

38
Q

Psammoma Bodies

A

Papillary Carcinoma

Concentric circular calcification

39
Q

Follicular Carcinoma

A

Malignant proliferation of follicles

40
Q

How would one distinguish histologically a follicular adenoma from follicular carcinoma?

A

Signs of malignancy:

  1. Vascular Invasion
  2. Tumor cells invade through capsule
41
Q

Can you distinguish follicular adenoma from carcinoma from FNA biopsy?

A

No!!!!

Would need to see whole specimen

42
Q

How does follicular carcinoma like to spread?

A

Hematogenously

Different, because normally carcinoma’s like to spread through lymph nodes

43
Q

Medullary Carcinoma

A

Malignant proliferation of parafollicular C Cells

44
Q

What type of tumor is a medullary Carcinoma?

A

Endocrine Tumor! Secrete Calcitonin (may lead to hypocalcemia)

(Papillary and Follicular are epithelial tumors)

45
Q

In a medullary tumor calcitonin often deposits with in tumor as ______

A

Amyloid!

46
Q

What would a FNA of medullary carcinoma look like?

A

Malignant cells in an amyloid stroma

47
Q

Which MEN syndromes is medullary carcinoma associated with? What is the genetic mutation?

A

MEN 2A & 2B

Mutation in RET gene

48
Q

Anaplastic Carcinoma

A

Undifferentiated malignant tumor of thyroid

Usually seen in elderly

Invades local structures leading to dysphagia or respiratory compromise

POOR PROGNOSIS

HRM Test 1 (11 decks)

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