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Thyroid pathology Flashcards

1
Q

What are the three embryological abnormalities of the thyroid gland?

A

Lingual thyroid gland
Thyroglossal duct cyst
Retrosternal thyroid gland

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2
Q

How is the thyroid gland arranged histologically?

A

Follicles containing thyroglobulin and lined by follicular epithelium
Scattered C cells/parafollicular cells

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3
Q

What do C cells secrete?

A

Calcitonin

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4
Q

What does calcitonin do?

A

Reduces blood calcium levels (minimally relevant)

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5
Q

Which thyroid-related hormone is secreted from the hypothalamus to act on the anterior pituitary?

A

Thyrotropin releasing hormone

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6
Q

Which thyroid-related hormone is secreted from the anterior pituitary to act on the thyroid?

A

Thyroid stimulating hormone

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7
Q

Which hormones are secreted from the thyroid in response to hormonal stimulation from the pituitary?

A

Triodothyronin (T3)

Thyroxine (T4)

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8
Q

Which specific cells of the thyroid does thyroid stimulating hormone act on?

A

Thyroid follicular epithelium

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9
Q

Which receptor does thyroid stimulating hormone bind to? Where is this receptor found?

A

TSH receptor on follicular epithelium

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10
Q

Which type of receptor is TSH receptor?

A

G-protein coupled receptor

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11
Q

How do G-protein coupled receptors work?

A

Convert GTP to GDP to produced cAMP which increases the production of thyroid hormones

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12
Q

T3 and T4 only circulate when bound to plasma proteins. T/F

A

False - they exist in bound or free forms

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13
Q

How do T3/4 work on target tissues?

A

Bind to target cells >
Bound T3/4-receptor complex translocates to the cell nucleus >
Binding to thyroid response elements on target genes >
Gene transcription and increase in BMR

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14
Q

When might the thyroid gland atropy?

A

When its function is reduced

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15
Q

Enlarged thyroid glands are capable of causing breathing and/or swallowing difficulties. T/F

A

True - if thyroid glands enlarge enough they can cause local mass effects

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16
Q

Define the terms thyrotoxicosis and hyperthyroid

A

Thyrotoxicosis - too much thyroid hormone

Hyperthyroid - hyper function of the thyroid tissues

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17
Q

Is there a genetic component to autoimmune thyroid disease?

A

Yes

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18
Q

What autoimmune condition is associated with autoimmune thyroid disease?

A

Vitiligo

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19
Q

What is the most common cause of hyperthyroidism?

A

Grave’s disease

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20
Q

What is a pituitary cause of thyrotoxicosis?

A

TSH secreting pituitary adenoma

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21
Q

Name a cause of ectopic thyrotoxicosis

A

Struma ovarii

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22
Q

Grave’s disease is autoimmune. T/F

A

True

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23
Q

Is graves disease more common in woman or men?

A

Woman

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24
Q

What age group typically presents with Grave’s disease?

A

20-40 y/o

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25
Q

What are the antibodies against in Grave’s disease?

A

Thyroid stimulating hormone receptor
Thyroglobulin
Thyroid peroxisomes

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26
Q

Name an anti TSH receptor antibody involved in Grave’s

A

Thyroid stimulating immunoglobulin

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27
Q

What is the triad of features found in Grave’s disease?

A

Hyperthyroidism with diffuse goitre
Exopthalamos (TED)
Pretibial myxoedema

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28
Q

Why do you get thryoid eye disease in Grave’s?

A

Fibroblasts within the eye and surrounding tissues express TSH receptors

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29
Q

What is the most common cause of hypothyroidism?

A

Hashimoto’s thyroiditis

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30
Q

Is hashimoto’s thyroiditis autoimmune?

A

Yes

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31
Q

Who typically gets Hashimoto’s thyroiditis?

A

Middle aged woman

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32
Q

Is Hashimoto’s thyroiditis associated with other autoimmune conditions? Is it associated with HLA?

A

Yes & yes

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33
Q

What are secondary and tertiary causes of hypothyroidism?

A

Pituitary tumour

Hypothalamic tumour

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34
Q

What are other causes of hypothyroidism?

A

Iodine deficiency
Lithium medication
Iatrogenic (hyperthyroidism treatment)

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35
Q

Is hashimoto’s thyroiditis more common in woman or men?

A

Women

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36
Q

What is the typical age range who gets hashimoto’s thyroiditis?

A

45-60 y/o

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37
Q

Does hashimoto’s thyroiditis have a genetic component?

A

Yes

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38
Q

What anti-thyroid antibodies are associated with hashimoto’s thyroiditis?

A

Anti-thyroglobulin

Anti-peroxisome

39
Q

What is hashitoxicosis?

A

Transient hyperthyroidism that can precede hashimoto’s thyroiditis

40
Q

Which two things is hashimoto’s thyroiditis associated with?

A

Autoimmune conditions

B cell non-hodkin’s lymphoma

41
Q

What is a goitre?

A

Enlargement of the thyroid gland

42
Q

Which dietary deficiency is goitre/goitre-producing conditions associated with?

43
Q

What is the typical pathogenesis of goitre?

A

Reduced thyroid hormones >

TSH increased and results in enlarged gland >

44
Q

How does a hypothyroid goitre occur?

A

Compensation for reduced thyroid hormone fails resulting in hypothyroid goitre

45
Q

What is the term for a state of normal thyroid hormone levels?

46
Q

Doe males or females get diffuse goitre more commonly?

47
Q

Why might adolescents/young adults present with diffuse goitre?

A

Dyshormonogenesis (errors of metabolism)

48
Q

How do young patients with diffuse goitre typically present?

A

Euthyroid with mass effect symptoms (subclinical hypothyroid)

49
Q

What may dyshormonogensis’ cause in children?

50
Q

Can multi-nodular goitre evolve from a long standing diffuse goitre?

51
Q

What mass effects can goitre cause?

A

Dysphagia
Difficulty breathing
Vessel compression

52
Q

What is the risk of malignancy with a multinodular goitre?

A

Low but present

53
Q

Which cells do follicular and papillary thyroid carcinomas come from?

A

Follicular

54
Q

Which cells does medullary thyroid carcinoma come from?

A

Parafollicular C cells

55
Q

How do follicular adenomas present?

A

Discrete solitary mass +/- local symptoms if large

56
Q

Are thyroid adenomas functional?

A

Most are not

Those which are most often cause hyperthyroid (TSH independent)

57
Q

What is follicular adenoma often mistaken for?

A

Dominant nodule in multinodular goitre

Follicular carcinoma

58
Q

Do males or females more commonly get thyroid cancer?

A

Females (apart from children and elderly)

59
Q

When do thyroid cancers present?

A

Early adulthood

60
Q

What is papillary cancer associated with?

61
Q

What is follicular cancer associated with?

A

Iodine deficiency

62
Q

What is medullary cancer associated with?

A

Multiple endocrine neoplasia type 2

Familial medullary cancer

63
Q

What type of goitre does papillary cancer cause?

A

Solitary thyroid nodule - multifocal, cystic, calcified

64
Q

Does papillary cancer spread by lymph or blood?

65
Q

Does follicular cancer spread by lymph or blood?

66
Q

How does papillary cancer typically present?

A

Hoarseness
Dysphagia
Cough
Dysphonia

67
Q

What type of goitre does follicular cancer cause?

A

Slowly enlarging, painless, solitary nodule

68
Q

Where does follicular cancer tend to spread?

A

Bones, lungs, liver

69
Q

What age group typically gets follicular cancer?

A

Middle aged

70
Q

How common is medullary thyroid cancer?

71
Q

What can medullary thyroid cancers secrete?

A

Calcitonin

72
Q

In which scenario would a medullary cancer arise in a 1) young patient and 2) an adult?

A

1 - MEN

2 - Familial/sporadic

73
Q

What is the difference between sporadic and familial medullary cancer cases?

A

Sporadic - solitary nodule

Familial - bilateral/multicentric

74
Q

How does medullary cancer present?

A 
Hoarseness
Airway compression
Dysphagia 
Diarrhoea 
Cushings
75
Q

What causes paraneoplastic 1) diarrhoea and 2) cushings?

A

1 - VIP

2 - ACTH

76
Q

What is the most aggressive thyroid cancer?

A

Anaplastic

77
Q

In which age range does anaplastic cancer present?

78
Q

Which cancer occurs in people with a history of thyroid cancer?

A

Anaplastic

79
Q

How is thyroid cancer classified?

A 
Th1 - repeat test
Th2 - benign
Th3 - atypia probably benign
Th4 - atypia probably malignant
Th5 - malignant
80
Q

How many parathyroid glands are there?

81
Q

Which cells compose the parathyroid glands?

A

Chief cells and oxyphil cells

82
Q

What do chief cells secrete and what is its effect?

A

Parathyroid hormone affecting calcium metabolism

83
Q

What is the most common cause of hyperparathyroidism?

A

Parathyroid adenoma

84
Q

What is parathyroid hyperplasia associated with?

A

Multiple endocrine neoplasia 1 & 2

85
Q

What is the difference in terms of gland involvement between parathyroid adenomas and hyperplasia

A

Adenoma - one gland involved and others atrophic

Hyperplasia - all glands involved

86
Q

What chronic metabolic state can cause secondary hyperparathyroidism?

A

Hypocalcaemia

87
Q

What are the two most common causes of chronic hypocalcaemia?

A

Renal failure

Vitamin D deficiency

88
Q

What is tertiary hyperparathyroidism associated with?

A

Hypercalcaemia

89
Q

What is the presentation of hyperparathyroid disease?

A

Bone (pain, fracture, osteoporosis)
Nephrolithiasis (kidney stones)
GI complications (constipations, nausea, gall stones)
CNS (depression)
Neuromuscular (weakness, fatigue)
CVS (calcification of aortic and mitral valves)

90
Q

How common is hypoparathyroid?

91
Q

What are the common causes of hypoparathyroid?

A

Iatrogenic (post-surgery)
Di George syndrome (congenital)
Familial

92
Q

What are the associations with familial hypoparathyroidism?

A

Adrenal insufficiency

Mucocutaneous candidiasis

93
Q

How does hypoparathyroid present?

A 
Tetany
Altered mental state
Parkinsonian 
Raised ICP --> papilloedema 
Calcification of lens and cataracts
Dental abnormalities (if during development)

Year 2 (72 decks)

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