Thyroid Pathologies Flashcards
A goiter can be caused by hypo or hyperthyroid conditions (TRUE/FALSE)?
TRUE
What is a goiter?
Enlarged thyroid gland
What is an endemic goiter?
Goiter caused by low intake of iodine –> insufficient production of T3/T4
(occurs in certain geographic areas)
What is a non-toxic goiter?
A enlarged thyroid that is not hypersecreting TH and survives without functional, inflammatory, or neoplastic changes (pt is euthyroid)
What is a toxic goiter?
A diffuse goiter that is hypersecreting thyroid hormone
What is the histological presentation of a toxic goiter?
Diffuse
A toxic goiter shows up (hot/cold) on a thyroid uptake scan
hot (due to ^TH)
A patient with an endemic goiter has ____thyroidism
hypo
A patient with a non-toxic goiter has ____thyroidism
eu
(normal)
A patient with a toxic goiter has ____thyroidism
hyper
(thyroid toxicosis)
What is the gold standard of diagnosis for a thyroid condition?
Fine needle aspiration
What is the largest purely endocrine gland in the body?
Thyroid
A patient with hyperthyroidism will have (Low/High) levels of T3/T4
High
What hormone establishes basal metabolic rate?
Thyroid hormone
A patient with hyperthyroidism will have (Low/High) levels of TRH
Low
A patient with hypothyroidism will have (Low/High) levels of T3/T4
Low
A patient with hypothyroidism will have (Low/High) levels of TRH
High
A patient with hyperthyroidism will have a (Low/High) basal metabolic rate
High
A patient with hypothyroidism will have a (Low/High) basal metabolic rate
Low
A patient with hyperthyroidism will generally have a (Low/High) BMI
Low
A patient with hypothyroidism will generally have a (Low/High) BMI?
High
A patient with hyperthyroidism will generally have a (Low/High) level of brain activity
High
A patient with hypothyroidism will generally have a (Low/High) level of brain activity
Low
A patient with hyperthyroidism will have (hyper/hypo)reflexia
Hyper
A patient with hypothyroidism will have (hyper/hypo)reflexia
Low
A patient with hyperthyroidism will have (Tachycardia/Bradycardia)
Tachycardia
A patient with hypothyroidism will have (Tachycardia/Bradycardia)
Bradycardia
A patient with hyperthyroidism will have (Tachypsnea/Bradypsnea)
Tachypsnea
A patient with hypothyroidism will have (Tachypsnea/Bradypsnea)
Bradypsnea
A patient with hyperthyroidism will have (Diarrhea/Constipation)
Diarrhea
A patient with hypothyroidism will have (Diarrhea/Constipation)
Constipation
Oligomenorrhea is present in females with both hypothyroidism and hyperthyroidism (TRUE/FALSE)
TRUE
A patient with hypothyroidism will have (Oily/Loss of) hair
Loss
A patient with hyperthyroidism will have (Loss/Oily) (of) hair
Oily
What is the term for the lateral loss of eyebrow hair seen in hypothyroidism?
“Queen Anne’s Sign”
A patient with hyperthyroidism will feel (Warm/Cold) internally and on their skin
Warm
A patient with hypothyroidism will feel (Warm/Cold) internally and on their skin
Cold
A patient with hypothyroidism will have (Myxedema/Exophthalmos)
Myxedema
A patient with hyperthyroidism will have (Myxedema/Exophthalmos)
Exophthalmos
A patient with hyperthyroidism will likely suffer from (Anxiety/Depression)
Anxiety
A patient with hypothyroidism will likely suffer from (Anxiety/Depression)
Depression
A patient with hypothyroidism will present with thrills on auscultation (TRUE/FALSE)
False (N/A)
What three conditions produce hyperthyroidism?
Graves Disease
De Quervains Subacute thyroiditis
Reidel’s thyroiditis (tends toward hypo)
Reidel’s thyroiditis causes hyperthyroidism early and hypothyroidism later on in its course (TRUE/FALSE)
TRUE
What is the most common cause of hyperthyroidism?
Grave’s disease
What is the most prevalent autoimmune disease in the US?
Grave’s disease
What is the most common cause of hypothyroidism?
Hashimoto’s
What is the cause of Grave’s disease?
Type II hypersensitivity reaction where the body makes an antibody against the TSH receptor which causes overactivation of the receptor
What is the histological and gross presentation of a goiter with grave’s disease?
Diffuse toxic goiter
What are the three conditions that cause hypothyroidism?
Cretinism
Myxedema
Hashimoto’s
What is Hashimoto’s thyroiditis?
Type II hypersensitivity reaction where the body makes an antibody against the thyrocyte cells and destroys them
Subacute thyroiditis is also called ____
de Quervain thyroiditis
What pattern of inflammation is seen in a patient with De Quervains subacute thyroiditis?
Granulomatous
What is the most common etiology of De Quervains subacute thyroiditis?
Upper respiratory viral infections (ie. Influenza, adenovirus, echovirus, or coxsackie virus)
What is the average gender and age for a patient with De Quervain’s thyroiditis?
30-50 year old female
A 27 year old female patient presents to your office with complaints of losing weight and excessive sweating. She is always feeling anxious and her heart rate is elevated to 112 BPM. She complains of irregular menstrual cycles and that the room is “too hot” for her. Blood test shows an antibody against TSH receptors. What condition is she expressing?
Grave’s Disease
33 year old female patient presents to your office one week after an upper respiratory illness. She reports losing around 10 pounds over the last week and is noted to be trembling in her seat. Upon cervical palpation you note that the anterior aspect of her neck around C4/C5 is tender to the touch and moderately swollen. What is the likely diagnosis?
De Quervains subacute thyroiditis
What is cretinism? How is acquired?
Hypothyroidism in pediatric patients caused by low levels of iodine or two parents who are hypothyroid in endemic nations
What is the pathogenesis of De Quervain’s subacute thyroiditis?
Granulomatous inflammation destroys follicles releasing thyroid hormone
What are the clinical features of subacute thyroiditis?
- self-limiting (goes away on its own)
- pt has preceding recovery from viral infection
- painful goiter (enlarged & tender)
- may have fever, malaise, fatigue, neck pain radiating to jaw
- hoarseness & dysphagia
What is Reidel’s thyroiditis?
- Systemic immune complex disease that turns the thyroid into scar tissue causing initial hyperthyroidism and eventual hypothyroidism once the thyroid is effectively destroyed.
- Involves extrathyroidal soft tissues of the neck and progressive fibrosis in other locations.
What are the clinical features of Reidel’s thyroiditis?
- gradual onset
- painless goiter w/ hard/”stony” feel
- may have fibrosing lesions at other sites (i.e., retroperitoneum, mediastinum, retro-orbital tissue)
- compression of neck organs: stridor, dysphagia, hoarseness
Compression of the trachea by a goiter causes ____
stridor (high pitch musical sound)
Compression of the esophagus by a goiter causes ____
dysphagia
Compression of the recurrent laryngeal nerve by a goiter causes ____
hoarseness
42 year old female patient presents to your office with the chief complaint of difficulty swallowing that has become increasingly worse over the past few months. Her voice is hoarsened and she has some difficulty talking for long periods of time. Upon palpation of the anterior aspect of her neck you notice a stony hard palpatory feeling like a rock on the patients thyroid. What is the likely diagnosis?
Reidel’s thyroiditis
Reidel’s thyroiditis can be classified closely to what type of hypersensitivity reaction? Why?
Type III because immune complexes are being deposited in the area around the thyroid and an antibody is made against a soluble antigen
7 year old male patient of Malaysian descent presents to your office with his mother today. The patients are immigrants and the child speaks very little English. The mother reports that the child has failed to reach his intelligence quotient benchmarks for his age and thinks that a C1 triple thenar occipital upper body drop is what her son needs. Upon inspection you notice that the patient has a very low set hair line, a squared face, and a protruding tongue. What is the likely diagnosis for this patient. How would his thyroid hormone levels present?
Cretinism with low levels of T3/T4
What is the treatment for hypothyroidism?
Exogenous thyroid hormone replacement such as thyroxine or synthroid
35 year old female patient present to your office complaining of weight gain and wanting nutritional support. Her vitals show a low heart rate and blood pressure of 110/62. She reports irregular menstruation for the last few months. Her reflexes measure a 1j+ in the knee and elbow. Blood tests show elevated TRH and TSH but decreased T3/T4. What is the patients diagnosis and where is the problem?
- Hashimoto’s
- thyroid
Goitrous hypothyroidism is due to ____
Lack of iodine (defective TH synthesis)
What is myxedema and what condition is it commonly seen in?
- Deposition of mucopolysaccharides in dermis leading to swelling
- used synonymously w/ severe hypothyroidism in adults AND to describe dermatologic changes
How does myxedema present in a patient with hypothyroidism?
- often seen in the face (periorbital)
- puffy eyelids, hands & feet
- often w/ carpal tunnel syndrome
What are the causes of cretinism?
Endemic, sporadic, or familial
How is most cretinism caused?
Developmental defects of the thyroid (thyroid dysgenesis)
What are the clinical features of cretinism?
pediatric case
- growth & development defects
- delayed motor development
- mental retardation (low IQ)
- sluggish & apathetic infancy
- coarsened facial features
- protruding tongue
What is pretibial myxedema and what condition is it commonly seen in?
Bilateral NON-pitting edema in the lower extremity commonly seen in long-standing untreated Grave’s disease
Why does a patient with Grave’s disease present with pretibial myxedema?
The antibodies causing Grave’s disease will cause overactivation of TSH receptors on fibroblasts in the area of the tibia causing increased amounts of collagen and ECM in the area resulting in bilateral non-pitting edema
Myxedema is a form of ____ edema
Non-pitting
Carpal tunnel syndrome often copresents with what form of hypothyroidism?
Myxedema
What is the most common benign thyroid tumor?
Follicular adenoma
What is the most common malignant thyroid tumor?
Papillary carcinoma
Orphan Annie nuclei, Psammoma bodies, and papillary projections are indicative of what pathology?
Papillary carcinoma
Psammoma bodies are indicative of what pathology?
Papillary carcinoma
What causes Psammoma bodies in a papillary carcinoma of the thyroid?
Dystrophic calcification causing dense fibrosis with calcospherites
What thyroid hormone levels would you expect for a patient with a follicular adenoma?
euthyroid (normal)
Follicular carcinomas show up (hot/cold) on thyroid uptake scans
cold
(“cold” nodules)
What is often the first presenting sign of a follicular carcinoma?
patho Fx through bony metastasis OR pulmonary lesion
What is a follicular carcinoma comprised of?
purely follicular (NO papillary projections/psammoma bodies/orphan annie nuc./CT capsule)
What are the clinical features of a follicular carcinoma?
- present as solitary palpable nodules or enlarged thyroids
- tend to remain clinically silent until metastasis
- “cold” on scan
Medullary carcinoma is derived from ____
C cells of the thyroid which secrete calcitonin, and as a result may secrete multiple hormones
Where does medullary carcinoma tend to arise?
superior portion of thyroid (richest in C cells)
What are the clinical features of medullary carcinoma?
- symptoms related to endocrine secretion (eg. carcinoid syndrome (serotonin), Cushing syndrome (ACTH))
- watery diarrhea in 1/3 of pts caused by secretion of vasoactive intestinal peptide
What is the most severe malignant thyroid tumor?
anaplastic carcinoma
What are the clinical features of anaplastic carcinoma?
- rapidly enlarging neck mass
- dysphagia, dyspnea, hoarseness, stridor (compresses trachea)
How does anaplastic carcinoma present histologically?
poorly differentiated & circumscribed mass in the gland, extending into other tissues
Male patient age 35 presents to your office after noticing an enlarging lump on the front of their neck. Upon palpation you find it is round, moveable and ill-defined. She reports some pain in the area, and says it has been difficult to swallow lately, and has noticed changes in her voice. Blood tests show normal thyroid levels, and fine needle aspiration shows follicular differentiation. What is the likely diagnosis?
follicular adenoma
Female patient age 30 presents to your office with complaints of swollen lymph nodes around her neck. Upon palpation you notice cervical lymphadenopathy. A biopsy is performed and shows dense calcospherites with whorls of tumor cells. Furthermore, finger-like projections are noted in the slide with holo nuclei. What is the likely diagnosis?
Papillary carcinoma
Male patient aged 55 presents to your office complaining of pain from his loin that radiates into his groin. For the past few months he has noticed a general lack of energy as well as an inability to focus on anything at work. Furthermore, he has reported a decreased appetite due to stomach pain and pain just below his ribs that feels like a stabbing sensation after he eats. Blood report shows calcium levels of 11.1 Mg/dL. What is the primary cause of hypercalcemia and the likely cause of this patients complaint? What is he also at risk for?
Parathyroid adenoma with an increased risk of peptic ulcers and pathological fracture
What is Chvostek’s sign?
Doctor taps on the parotid gland on the lateral aspect of the face and is looking for tetany of the facial muscles to demonstrate hypocalcemia
What is Trousseau’s test?
Doctor induces ischemia in an arm with a blood pressure cusp and is looking for the wrist to flex and ADduct to demonstrate hypocalcemia
Positive results for a Chvostek’s sign or Trousseau’s test indicate (Hypocalcemia/Hypercalcemia)?
Hypocalcemia
Female patient aged 55 presents to your office with a past MEN diagnosis. Her chief complaint today is of diarrhea that she describes as watery. Upon inspection you notice that she has severe truncal obesity, excessive facial hair for a woman, and stretch marks around her abdomen. She also complains recently about feeling depressed which she blames on her weight gain. Blood tests show abnormal serotonin levels and VIP. What is the likely diagnosis without a biopsy? If a biopsy were performed what would you expect to see and where?
Medullary carcinoma of the C cells of the thyroid with a tumor in the superior portion of the thyroid
30 year old female patient presents to your office with the chief complaints of difficulty swallowing and shortness of breath. Her husband has recently commented on the size of her neck which she admits has become much larger in the front in the past two months. A needle aspiration of the thyroid is ordered. Cells in the thyroid are poorly differentiated and are seen invading other tissues. What is the likely diagnosis?
Anaplastic carcinoma
What are multiple endocrine neoplasias (MEN)?
Groups of disorders that effect the endocrine system through the presentation of neoplastic lesions in specific locations
What is MEN 1 called?
Wermer’s Syndrome
What pathologies characterize MEN 1?
Pituitary Adenoma
Parathyroid hyperplasia/adenoma
Pancreatic islet cell tumor (insulinoma/gastrinoma)
PPP
What pathologies characterize MEN 2?
Thyroid medullary carcinoma
Adrenal medulla pheochromocytoma
Parathyroid adenoma
TAP
What is Men 2 called?
Sipple’s Syndrome
48 year old female patient presents to your office with the chief complaint of stomach pain and generalized fatigue. Notable history findings include: Increased milk secretion despite no pregnancy as well as amenorrhea for the past 5 months. Blood tests are ordered. Blood tests show calcium levels of 10.9 mg/dl, phosphate levels of 2 mg/dl, and hypoglycemia. What is the likely diagnosis?
MEN I
45 year old female patient presents to your office with complaints of watery diarrhea lasting for the past month. Notable history findings include: No history of a foodborne illness or autoimmune/digestive issue, recent fits of rage and excessive sweating. Blood tests are ordered and show hypercalcemia (10.7 mg/dl), hypertension (145/95). The patients heart rate is markedly increased and tachycardia is noted at 125 BPM. A urine test shows catecholemines in the urine. What is the likely diagnosis?
MEN II
Riedel’s thyroiditis is considered to be a ____ disease
IgG-related systemic disease
Patient presents with hoarseness & dysphagia as well as fever, malaise and fatigue. What 2 differential diagnoses would you consider? What clinical feature would differentiate the 2?
Pharyngitis
Subacute Thyroiditis - enlarged, tender thyroid on palpation (self-limiting)
