Thyroid Pathology

Question 1

What is this?

Acute elevation of catecholamine levels. Febrile, tachycardia. After infection, surgery, cessation of antithyroid meds

Answer 1

thyroid storm - Abrupt onset of severe hyperthyroidism

Question 2

Lab dx of hyperthyroidism

Answer 2

Low serum TSH, then confirmed by increased free T4

Question 3

What happens with radioactive iodine uptake in these:

1. Graves Disease
2. Toxic adenoma
3. Thyroiditis

Answer 3

1. Diffusely increased, entire gland.
2. Increased in solitary nodule
3. Decreased uptake

Question 4

Four overall changes in hyperthyroidism

Answer 4

1. Increased basal metabolic rate
2. Cardiac - cadiomyopathy/CHF/afib
3. Ophthalmopathy
4. Overactivity of SNS

Question 5

Drugs that can cause hypothyroidism

Answer 5

Lithium, iodides, p-aminosalicylic acid

Question 6

What type of hypothyroidism is this: hypothalamic deficiencies in TSH, or more uncommonly, TRH. Due to any cause of hypopitutiary or hypothalamic damage/tumors/radiation/disease

Answer 6

Secondary (central) hypothyroidism

Question 7

A child from the Himalayas, China, Africa with clinical features of severe mental retardation, short stature, coarse facial features, protruding tongue, umbilical hernia, skeletal and CNS impairment.

Answer 7

Cretinism (childhood hypothyroidism)

Question 8

Older child or adult

• fatigue, apathy, mental sluggishness
• cold intolerance
• overweight
• enlargement of tongue, deepnening of voice
• Constipation, reduced CO

Answer 8

Myxedema (adult hypothyroidism)

Question 9

Lab dx of myxedema

Answer 9

Serum TSH – will not be elevated in hypothyroidism due to primary hypothalamic or pituitary disease

Question 10

Three manifestations of thyroiditis

Answer 10

1. Hashimoto Thyroditis
2. Granulomatous (de Quervain)
3. Thyroiditis Subacute lymphocytic thyroiditis

Question 11

Increased susceptibility to Hashimoto and Graves

associated with polymorphisms in what two immune regulation-associated genes?

Answer 11

CTLA4 and PTPN22

Question 12

Clinical course of what?
A middle age female presents with painless, symmetric, diffuse enlargement of thyroid. Transient thyrotoxicosis dt follicle disruption (hashitoxicosis)

Answer 12

Hashimoto thyroiditis

Question 13

People with Hashimoto increased risk for what other autoimmune diseases and neoplasms?

Answer 13

• Endocrine - Type 1 diabetes, autoimmune adrenalitis,
• Nonendrocrine - SLE, myasthenia gravis, Sjogren
• Neoplasm - Extranodal marginal zone B cell lymphoma within thyroid gland

Question 14

Hashimoto: Thyroid parenchyma contains _____ with dense lymphocytes, plasma, cells with well developed _____.

Answer 14

• monomorphic nuclear inflammatory infiltrate

- germinal centers

Question 15

Hashimoto: Residual thyroid follicles lined by abundantly _____, granular cytoplasm. This is called ____.

Answer 15

• Eosinophilic

- Hurthle Cells

Question 16

Does fibrosis in Hashimoto extend beyond the capsule?

Answer 16

no

Question 17

Clinical presentation of what:

Mild Hyperthyroidism and/or goitrous enlargement COT (10 years) 1/3 progress to hypothyroidism

Answer 17

Subacute Lymphocytic (Painless) Thyroiditis

Question 18

What process resembles Subacute Lymphocytic (Painless) Thyroiditis, but occurs in ~5% of women after childbirth?

Answer 18

Postpartum thyroiditis

Question 19

Most Subacute Lymphocytic (Painless) Thyroiditis have circulating ____ antibodies of FH of other autoimmune disorders

Answer 19

antithyroid peroxidase antibodies

Question 20

A female in her 40-50s presents with thyroid pain, transient inflammation and hyperthyroidism (diminished in 2-6 weeks). After recovery ,6-8 wks for normal thyroid function to return.

Answer 20

Clinical presentation fo granulomatous thyroiditis

Question 21

Labs in Granulomatous Thyroiditis

Answer 21

High serum T3/T4, low serum TSH

**Radioactive iodine diminished

Question 22

What is the name of this (less common) form of thyroiditis: extensive fibrosis of thyroid and contiguous neck structures. Fixed and hard thyroid mass, clinically simulating thyroid carcinoma. May be associated wiht fibrosis in other areas of the body and may be a manifestation of a systemic autoimmune IgG4 related disease.

Answer 22

Reidel Thyroiditis

Question 23

In Granulomatous Thyroiditis, the Early Active Inflammatory Phase is defined morphologically by follicles replaced by ______ forming _____

Answer 23

Neutrophils forming microabscesses.

Question 24

In Granulomatous Thyroiditis, in the Later phase - aggregates of lymphocytes, activated macrophages, plasma cells. Thyroid parenchyma contains a chronic inflammatory infiltrate with a ______ that enclose naked pools or fragments of colloid. Later, fibrosis may replace foci of injury.

Answer 24

Multinucleated giant cell