Thyroid Pathology Flashcards
Which is more likely to be a carcinoma:
hot or cold spots
cold (but still most likely to be benign)
Lid lag
when eyes move down, eye lid lags behind movement
because of hyperthyroidism
excessive sympathetic activation
sympathetics hold open eye lid
*other is from CNIII via levator palpibrae
Most common cause of hyperthyroidism in US
Grave’s disease
stimulatory anti-TSH receptor antibody
Most common cause of congenital hypothyroidism
iodine deficiency
Most common cause of hypothyroidism in US
Hashimoto thyroiditis
autoimmune destruction of thyroid gland
Etiology of thyroiditis
autoimmune destruction F>M
Hashimoto thyroiditis
etiology
consequences
autoimmune attack of thyroid gland
results in hypothyroidism
Antibody in Hashimoto thyroiditis
anti-peroxidase antibody
Hürthle cells seen in
Hashimoto thyroiditis
DeQuervain Thyroiditis
etiology
consequences
Tx
acute autoimmune thyroiditis after acute URI
*initially leads to transient hyperthyroidism as follicles destroyed and T4 released
*then hypothyroidism
self-limiting, let run course
Pathology findings of DeQuervain thyroiditis
multinucleated giant cells, ie foreign body giant cells
from colloid leaked from damaged follicles
Silent thyroiditis
silent, doesn’t cause problems
possible hyperthyroidism early
Reidel thyroiditis
etiology
findings
fibrosis of thyroid –> rock hard thyroid
rock hard neck mass, tracheal compression, hypothyroidism
Grave’s triad
hyperthyroidism
opthalmopathy w/ exopthalmos
dermopathy-pretibial thickening of skin
Iodine scan of Grave’s
diffuse increased uptake
1˚ hyperthyroidism
Multinodular goiter
etiology
bands of fibrosis from repeated trauma to simple goiter
How can you get goiter when there is hypothyroidism
low T4 leads to high TSH
TSH stimulates the heck out of the thyroid
thyroid is active and gets all big
Best way to figure out what’s in a thyroid nodule
fine needle Bx
Tx of thyroid adenoma
resection
because that’s the only way to prove they are adenomas
follicular carcinoma looks similar but has carcinoma invasion around the edge of the capsule
Order of thyroid carcinomas (4)
papillary thyroid carcinoma
follicular thyroid carcinoma
medullary thyroid carcinoma
anaplastic thyroid carcinoma
Papillary thyroid carcinoma
pathological findings
most common thyroid carcinoma
cystic structure grossly
“orphan Annie” nuclei, chromatin pushed off to sides, nuclei look like big empty eyes
Follicular thyroid carcinoma
pathological findings
2nd most common thyroid carcinoma
looks like adenoma, need to excise and look for invasive borders
mets to bone and lung
Medullary thyroid carcinoma
pathological findings
C-cell malignancy (endocrine tumor)
may be familial as in MEN
**amyloid on H&E, salt and pepper chromatin
Anaplastic thyroid carcinoma
pathology
very bad, invasive
fast growing
mets at Dx
