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Zak, Endo/Repro 2 > Thyroid Pathology > Flashcards

Thyroid Pathology Flashcards

1
Q

What is Thyrotoxicosis?

A

Hypermetabolic state caused by elevated circulating levels of free T3/T4

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2
Q

What are 4 examples of disorders of Thyrotoxicosis NOT associated with hyperthyroidism?

A

Granulomatous Thyroiditis (De Quervain)
Subacute Lymphoctyic Thyroiditis
Struma Ovarii
Factitious Thyrotoxicosis

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3
Q

What are the major Sx’s of hyperthyroidism?

A

Increased BMR, tachycardia, tremor, hyperstimulation of gut, wide staring gaze, osteoporosis

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4
Q

What is a thyroid storm?

A

Abrupt onset of severe hyperthyroidism with fever and tachycardia
*Medical emergency

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5
Q

What is apathetic hyperthyroidism?

A

Thyrotoxicosis in older adults that is seen only via lab work-up for unexplained weight loss or worsening CV disease

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6
Q

What would the lab findings be for apathetic hyperthyroidism?

A

Low serum TSH

Increased free T4

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7
Q

How much of the thyroid will take up radioactive iodine in Graves disease?

A

The whole gland (diffuse)

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8
Q

How much of the thyroid will take up radioactive iodine in a toxic adenoma?

A

Increased uptake in a solitary nodule

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9
Q

How much of the thyroid will take up radioactive iodine in thyroiditis?

A

Decreased uptake

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10
Q

Sx’s = mental retardation, short stature, coarse facial features, protruding tongue, umbilical hernia in children

A

Cretinism (hypothyroidism)

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11
Q

Sx’s = apathy, fatigue, mental sluggishness, cold intolerance, overweight, cool/pale skin, coarse facial features, cold intolerance in adult

A

Myxedema (hypothyroidism)

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12
Q

What can hypothyroidism do to cholesterol levels?

A

Increased total cholesterol

Increased LDL

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13
Q

What would the lab findings be in primary hypothyroidism?

A

Increased serum TSH

Decreased free T4

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14
Q

Which test is most sensitive for screening for hypothyroidism?

A

TSH

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15
Q

What would lab findings be in secondary hypothyroidism?

A

Decreased serum TSH

Decreased free T4

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16
Q

What is the difference between primary and secondary hypothyroidism?

A

Secondary is caused by pituitary or hypothalamic failure

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17
Q

What is Hashimoto thyroiditis?

A

Autoimmune destruction of thyroid gland leading to gradual thyroid failure (hypothyroidism)

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18
Q

Which Abs are found in Hashimoto thyroiditis?

A

Anti-microsomal
Anti-thyroid peroxidase
Anti-thyroglobulin

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19
Q

Which gene defects are associated with Hashimoto thyroiditis?

A

CTLA4

PTPN22

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20
Q

Morphology = Diffusely enlarged thyroid with atrophic follicles and Hurthle cell metaplasia

A

Hashimoto thyroiditis

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21
Q

Which cancer are pts at increased risk for if they Hashimoto thyroiditis?

A

Marginal zone B-cell lymphoma

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22
Q

What is the common presentation of a pt with Hashimoto thyroiditis?

A

Painless, symmetrically enlarged thyroid

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23
Q

Painless, mild hyperthyroidism that may cause a goiter and is the cause of Postpartum Thyroiditis

A

Subacute Lymphocytic Thyroiditis

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24
Q

Morphology = patchy distribution and collapse of thyroid follicles with NO fibrosis or Hurthle cell metaplasia

A

Subacute Lymphocytic Thyroiditis

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25
Q

1/3 of pts with _____ will evolve into overt hypothyroidism?

A

Subacute Lymphocytic Thyroiditis

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26
Q

What is another name for Granulomatous Thyroiditis?

A

De Quervain’s Thyroiditis

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27
Q

What is Granulomatous Thyroiditis?

A

Immune response triggered by a viral infection

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28
Q

Sx’s = painful, enlarged thyroid occurring after a URI causing transient hyperthyroidism for 2-6 weeks

A

Granulomatous Thyroiditis

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29
Q

What is the Tx for Granulomatous Thyroiditis?

A

Self-limited

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30
Q

Morphology = enlarged, firm thyroid stuck to surrounding structures with aggregates of lymphocytes, macrophages, and plasma cells, and damaged follicles

A

Granulomatous Thyroiditis

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31
Q

What are the lab values in Granulomatous Thyroiditis?

A

Low serum TSH

High serum T3/T4

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32
Q

What is the radioactive iodine uptake like in Granulomatous Thyroiditis?

A

Decreased uptake

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33
Q

What is Riedel Thyroiditis?

A

Extensive fibrosis of the thyroid and surrounding structures due to IgG4-related sclerosing disease (can affect other organs)

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34
Q

Form of Autoimmune IgG4-related sclerosing disease?

A

Riedel Thyroiditis

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35
Q

What is the most common cause of thyroid pain?

A

Granulomatous Thyroiditis

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36
Q

What is the most common cause of endogenous hyperthyroidism?

A

Graves disease

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37
Q

What is Graves disease?

A

Elevated T3/T4 due to stimulation of TSH receptors via Thyroid-Stimulating Immunoglobulin (TSI) and TSH receptor blocking Abs

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38
Q

What polymorphisms are associated with Graves disease?

A

CTLA4
PTPN22
HLA-DR3

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39
Q

What are the major Sx’s of Graves disease?

A

Diffuse thyroid enlargement, Hyperthyroidism
Exophthalmos
Infiltrative dermopathy (pretibial myxedema)

40
Q

What is the pathogenesis of exophthalmos?

A

Orbital preadipocytes express TSH receptor –> increased volume of retroorbital CT and extraocular muscles

41
Q

Morphology = Symmetric thyroid enlargement with tall, crowded follicular cells that lack a fibrovascular core, and pale colloid with scalloped margins

A

Graves disease

42
Q

What are the lab values seen in Graves disease?

A

Low serum TSH

High free T3/T4

43
Q

What is the radioactive iodine uptake like in Graves disease?

A

Diffusely taken up

44
Q

What is the Tx for Graves disease?

A

ß-blockers
Decrease thyroid hormone synthesis
Surgery

45
Q

Where are diffuse nontoxic goiters endemic?

A

Andes and Himalayas

46
Q

When do sporadic diffuse nontoxic goiters typically arise?

A

Puberty or young adult life

47
Q

What are the lab values seen in diffuse nontoxic goiters?

A

Elevated TSH

Normal T3/T4

48
Q

Most Sx’s of diffuse nontoxic goiters are due to what?

A

Mass effect

49
Q

What are multinodular goiters?

A

Long-standing simple goiters that convert to multinodular goiters

50
Q

What is the radioactive iodine uptake like in multinodular goiters?

A

Uneven uptake, may find “hot” nodule

51
Q

How do you evaluate the dominant nodule in multinodular goiters?

A

Fine needle aspiration (FNA)

52
Q

What is Plummer Syndrome?

A

When a nodule in a long-standing goiter becomes autonomous and produces hyperthyroidism

53
Q

What is another name for Plummer Syndrome?

A

Toxic Multinodular Goiter

54
Q

Which clues help to decide if a neoplasm is most likely neoplastic?

A

Solitary nodule
Found in younger pts
Found in males
History of radiation to head/neck

55
Q

Which clues help to decide if a neoplasm is most likely benign?

A

Multiple nodules
Found in older pts
Found in females
Presence of “hot” spots

56
Q

What is the best way to evaluate thyroid nodules?

A

Fine needle aspiration

57
Q

Sx’s = unilateral, painless mass that are generally non-functional

A

Follicular adenomas

58
Q

Morphology = solitary, encapsulated, well-demarcated lesions with uniform-appearing follicles and may see Hurthle cell metaplasia

A

Follicular adenomas

59
Q

What is the name for a Follicular adenoma if Hurthle cell metaplasia is seen?

A

Hurthle cell adenoma

60
Q

What do you look at to confirm a definitive Dx of Follicular adenoma?

A

Integrity of the capsule

61
Q

What increases the risk of developing Papillary carcinomas?

A

Exposure to ionizing radiation in early life

62
Q

What increases the risk of developing Follicular carcinomas?

A

Dietary iodine deficiency

63
Q

What gene mutations are seen in Follicular and Anaplastic carcinomas?

A

RAS
PI3K
PTEN

64
Q

What gene mutation is seen in Papillary carcinoma?

A

BRAF

65
Q

Morphology = areas of fibrosis and calcification with large overlapping nuclei having a clear/empty appearance (Ground glass or Orphan Annie Eye nuclei), and pseudo-inclusions

A

Papillary carcinoma

66
Q

Morphology = large, overlapping nuclei having a clear/empty appearance with follicular architecture

A

Follicular variant of PTC

67
Q

Morphology = Tall columnar cells with intensely eosinophilic cytoplasm lining the papillary structures

A

Tall-cell variant of PTC

68
Q

What mutations are associated with Tall-cell variant of PTC?

A

BRAF mutation

RET/PTC translocation

69
Q

Sx’s = asymptomatic thyroid nodules, possible cervical lymph node mass, hoarseness, dysphagia, cough, and dyspnea

A

Papillary carcinoma

70
Q

Which organ does metastasis usually occur to in Papillary carcinoma?

A

Lung

71
Q

What is the Tx for Papillary carcinoma?

A

Surgery

Radiation

72
Q

Which form of Papillary carcinoma has a poorer prognosis?

A

Tall-cell variant in older pts

73
Q

What factors contribute to the prognosis of Papillary carcinoma?

A

Age
Extrathyroid extension
Metastasis

74
Q

Morphology = single nodule containing small follicles with uniform cells (no nuclei like those in PTC) and may have Hurthle cell metaplasia

A

Follicular carcinoma

75
Q

What distinguishes Follicular adenoma VS carcinoma?

A

Carcinoma has invasion into/beyond the capsule

76
Q

Sx’s = slow growing, painless nodule with “cold” nodules

A

Follicular carcinoma

77
Q

What areas are most likely to have metastases in Follicular carcinoma?

A

Bone
Lungs
Liver

78
Q

What determines prognosis of Follicular carcinoma?

A

Extend of invasion and stage at presentation

79
Q

What is the Tx for Follicular carcinoma?

A

Surgery + radioactive iodine

Thyroid hormone administration

80
Q

What is serum product is used to monitor tumor recurrence in Follicular carcinoma?

A

Serum thyroglobulin

81
Q

Sx’s = rapidly enlarging neck mass with dyspnea, dysphagia, hoarseness, and cough

A

Anaplastic thyroid carcinoma

82
Q

Morphology = Undifferentiated, highly aggressive tumors

A

Anaplastic thyroid carcioma

83
Q

What is the Tx for Anaplastic thyroid carcinoma

A

There is no effective therapy

84
Q

How do Anaplastic thyroid carcinomas arise?

A

De novo

Dedifferentiation of papillary or follicular carcinomas

85
Q

What type of tumor is a neuroendocrine neoplasm derived from C (parafollicular) cells

A

Medullary thyroid carcinomas

86
Q

What are the familial forms of Medullary thyroid carcinomas associated with?

A

MEN 2A/2B

Familial Medullary Thyroid Carcinoma

87
Q

What gene mutation is seen in 1/2 of sporadic cases of Medullary thyroid carcinoma?

A

RET

88
Q

What is the presentation difference between sporadic and familial Medullary thyroid carcinoma?

A 
Sporadic = single nodule
Familial = multiple b/l foci
89
Q

Medullary thyroid carcinomas will stain + for?

A

Calcitonin

90
Q

What can be seen deposited in the stroma in Medullary thyroid carcinomas?

A

Amyloid

91
Q

What are the major Sx’s of sporadic Medullary thyroid carcinoma?

A

Paraneoplastic syndrome (diarrhea due to VIP) and normal Ca levels

92
Q

What is a useful tumor marker that is secreted in sporadic Medullary thyroid carcinoma?

A

Carcinoembryonic Ag (CAE)

93
Q

Pts diagnosed with MEN 2B are often given _____ as prophylactic Tx for Medullary thyroid cancer?

A

Thyroidectomy

94
Q

Morphology = cyst lined by stratified squamous epithelium in midline of neck

A

High-lying thyroglossal duct cyst

95
Q

Morphology = cyst lined by epithelium resembling thyroidal acinar epithelium in midline of neck

A

Low-lying thyroglossal duct cyst

Zak, Endo/Repro 2 (33 decks)

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