Thyroid Pathology

Question 1

What protein mix does the colloid contain?

Answer 1

glycoprotein mix

Question 2

What kind of cells are C cells?

Answer 2

neuroendocrine cells

Question 3

How does an inactive thyroid gland look under microscope?

Answer 3

low cuboidal cells

follicle filled with colloid

Question 4

How does an active thyroid gland look under microscope?

Answer 4

tall cuboidal to columnar cells

scalloping of colloid

Question 5

What are the signs of hypometabolic state?

Answer 5

cold intolerance
cold thickened skin
alopecia
weight gain
fatigue
SNS underactivity

Question 6

What are the signs of hypermetabolic state?

Answer 6

heat intolerance
warm flushed skin
fatigue
weight loss
osteoporosis 
SNS overactivity

Question 7

What is the risk of taking thyroxin as a weight loss pill?

Answer 7

there is possible osteoporosis

Question 8

What causes simple goitre?

Answer 8

impaired synthesis of thyroid hormone, and feedback induces spike of TSH

Question 9

What’s the most common cause of simple goitre?

Answer 9

dietary iodine deficiency

Question 10

What are the main features of simple goitre on histological slides?

Answer 10

cells are hyperplastic, follicles lined by crowded cells, follicle sizes are not uniform,

follicles have low cuboidal epithelium and abundant colloid, which can haemorrhage and grow larger

Question 11

Can simple goitre be nodular?

Answer 11

yes, overtime with cycles of hyperplasia

Question 12

What does simple goitre look like under radioactive iodine?

Answer 12

multinodular

Question 13

What’s the treatment of simple goitre?

Answer 13

surgery

Question 14

What does Hashimoto thyroid look under the microscope?

Answer 14

lymphocyte infiltration with germinal centres
scar tissue + fibrosis (increased interstitial connective tissue)
cells with large eosionophilic cytoplasms

Question 15

Does Hashimoto thyroid always atrophy?

Answer 15

No, it initially goes through a stage of hypertrophy

Question 16

What does the cut surface of Hashimoto thyroid look?

Answer 16

firm, tan-yellow, pale if fibrotic, somewhat nodular

Question 17

How does the thyroid tissue get damaged in Hashimoto?

Answer 17

tolerance breakdown leading to immunity against self

damage caused by CD8, cytokine, antibody-mediated damage, TSH-blocking antibody reducing further thyroid function

Question 18

T/F Hashimoto has a rapid onset

Answer 18

false, it has a gradual onset

Question 19

What are Hurthle cells?

Answer 19

thyroid cells with abundant, eosinophilic, granular cytoplasm

Question 20

What is the management of hypothyroidism?

Answer 20

hormone replacement

Question 21

What are the three clinical signs of Graves?

Answer 21

diffuse enlargement of thyroid
infiltrative ophthalmopathy with exophthalmos
localised infiltrative dermopathy

Question 22

which antibody can be found in the FBE of a Hashimoto patient?

Answer 22

TPO antibody

Question 23

what does the histology for Graves look like?

Answer 23

elongated cells

hyperplasia, crowded space, not much colloid

Question 24

What are the differences between Graves and simple goitre under the microscope?

Answer 24

Graves is diffused, and there is less colloid

Question 25

Which antibody can be found in Graves?

Answer 25

TSI
TGSI
TBII

Question 26

what is the function of TBII

Answer 26

stimulate or inhibit TSH receptor, therefore there can be (but rare) hypothyroidism in Graves

Question 27

What is the pathogenesis of opthalmpathy in Graves?

Answer 27

the fibroblasts at the orbital area express TSH-like antigens to trigger autoimmunity leading to inflammation, fibrosis and adipocyte transformation

Question 28

T/F Hashimoto is a type II, antibody mediated disease

Answer 28

False, it is a type IV, delayed type hypersensitivity

Question 29

which iodine is used to ablate the thyroid?

Answer 29

Iodine 131`