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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
1/3 of pts with _____ will evolve into overt hypothyroidism?
Subacute Lymphocytic Thyroiditis
26
What is another name for Granulomatous Thyroiditis?
De Quervain's Thyroiditis
27
What is Granulomatous Thyroiditis?
Immune response triggered by a viral infection
28
Sx's = painful, enlarged thyroid occurring after a URI causing transient hyperthyroidism for 2-6 weeks
Granulomatous Thyroiditis
29
What is the Tx for Granulomatous Thyroiditis?
Self-limited
30
Morphology = enlarged, firm thyroid stuck to surrounding structures with aggregates of lymphocytes, macrophages, and plasma cells, and damaged follicles
Granulomatous Thyroiditis
31
What are the lab values in Granulomatous Thyroiditis?
Low serum TSH | High serum T3/T4
32
What is the radioactive iodine uptake like in Granulomatous Thyroiditis?
Decreased uptake
33
What is Riedel Thyroiditis?
Extensive fibrosis of the thyroid and surrounding structures due to IgG4-related sclerosing disease (can affect other organs)
34
Form of Autoimmune IgG4-related sclerosing disease?
Riedel Thyroiditis
35
What is the most common cause of thyroid pain?
Granulomatous Thyroiditis
36
What is the most common cause of endogenous hyperthyroidism?
Graves disease
37
What is Graves disease?
Elevated T3/T4 due to stimulation of TSH receptors via Thyroid-Stimulating Immunoglobulin (TSI) and TSH receptor blocking Abs
38
What polymorphisms are associated with Graves disease?
CTLA4 PTPN22 HLA-DR3
39
What are the major Sx's of Graves disease?
Diffuse thyroid enlargement, Hyperthyroidism Exophthalmos Infiltrative dermopathy (pretibial myxedema)
40
What is the pathogenesis of exophthalmos?
Orbital preadipocytes express TSH receptor --> increased volume of retroorbital CT and extraocular muscles
41
Morphology = Symmetric thyroid enlargement with tall, crowded follicular cells that lack a fibrovascular core, and pale colloid with scalloped margins
Graves disease
42
What are the lab values seen in Graves disease?
Low serum TSH | High free T3/T4
43
What is the radioactive iodine uptake like in Graves disease?
Diffusely taken up
44
What is the Tx for Graves disease?
ß-blockers Decrease thyroid hormone synthesis Surgery
45
Where are diffuse nontoxic goiters endemic?
Andes and Himalayas
46
When do sporadic diffuse nontoxic goiters typically arise?
Puberty or young adult life
47
What are the lab values seen in diffuse nontoxic goiters?
Elevated TSH | Normal T3/T4
48
Most Sx's of diffuse nontoxic goiters are due to what?
Mass effect
49
What are multinodular goiters?
Long-standing simple goiters that convert to multinodular goiters
50
What is the radioactive iodine uptake like in multinodular goiters?
Uneven uptake, may find "hot" nodule
51
How do you evaluate the dominant nodule in multinodular goiters?
Fine needle aspiration (FNA)
52
What is Plummer Syndrome?
When a nodule in a long-standing goiter becomes autonomous and produces hyperthyroidism
53
What is another name for Plummer Syndrome?
Toxic Multinodular Goiter
54
Which clues help to decide if a neoplasm is most likely neoplastic?
Solitary nodule Found in younger pts Found in males History of radiation to head/neck
55
Which clues help to decide if a neoplasm is most likely benign?
Multiple nodules Found in older pts Found in females Presence of "hot" spots
56
What is the best way to evaluate thyroid nodules?
Fine needle aspiration
57
Sx's = unilateral, painless mass that are generally non-functional
Follicular adenomas
58
Morphology = solitary, encapsulated, well-demarcated lesions with uniform-appearing follicles and may see Hurthle cell metaplasia
Follicular adenomas
59
What is the name for a Follicular adenoma if Hurthle cell metaplasia is seen?
Hurthle cell adenoma
60
What do you look at to confirm a definitive Dx of Follicular adenoma?
Integrity of the capsule
61
What increases the risk of developing Papillary carcinomas?
Exposure to ionizing radiation in early life
62
What increases the risk of developing Follicular carcinomas?
Dietary iodine deficiency
63
What gene mutations are seen in Follicular and Anaplastic carcinomas?
RAS PI3K PTEN
64
What gene mutation is seen in Papillary carcinoma?
BRAF
65
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
Papillary carcinoma
66
Morphology = large, overlapping nuclei having a clear/empty appearance with follicular architecture
Follicular variant of PTC
67
Morphology = Tall columnar cells with intensely eosinophilic cytoplasm lining the papillary structures
Tall-cell variant of PTC
68
What mutations are associated with Tall-cell variant of PTC?
BRAF mutation | RET/PTC translocation
69
Sx's = asymptomatic thyroid nodules, possible cervical lymph node mass, hoarseness, dysphagia, cough, and dyspnea
Papillary carcinoma
70
Which organ does metastasis usually occur to in Papillary carcinoma?
Lung
71
What is the Tx for Papillary carcinoma?
Surgery | Radiation
72
Which form of Papillary carcinoma has a poorer prognosis?
Tall-cell variant in older pts
73
What factors contribute to the prognosis of Papillary carcinoma?
Age Extrathyroid extension Metastasis
74
Morphology = single nodule containing small follicles with uniform cells (no nuclei like those in PTC) and may have Hurthle cell metaplasia
Follicular carcinoma
75
What distinguishes Follicular adenoma VS carcinoma?
Carcinoma has invasion into/beyond the capsule
76
Sx's = slow growing, painless nodule with "cold" nodules
Follicular carcinoma
77
What areas are most likely to have metastases in Follicular carcinoma?
Bone Lungs Liver
78
What determines prognosis of Follicular carcinoma?
Extend of invasion and stage at presentation
79
What is the Tx for Follicular carcinoma?
Surgery + radioactive iodine | Thyroid hormone administration
80
What is serum product is used to monitor tumor recurrence in Follicular carcinoma?
Serum thyroglobulin
81
Sx's = rapidly enlarging neck mass with dyspnea, dysphagia, hoarseness, and cough
Anaplastic thyroid carcinoma
82
Morphology = Undifferentiated, highly aggressive tumors
Anaplastic thyroid carcioma
83
What is the Tx for Anaplastic thyroid carcinoma
There is no effective therapy
84
How do Anaplastic thyroid carcinomas arise?
De novo | Dedifferentiation of papillary or follicular carcinomas
85
What type of tumor is a neuroendocrine neoplasm derived from C (parafollicular) cells
Medullary thyroid carcinomas
86
What are the familial forms of Medullary thyroid carcinomas associated with?
MEN 2A/2B | Familial Medullary Thyroid Carcinoma
87
What gene mutation is seen in 1/2 of sporadic cases of Medullary thyroid carcinoma?
RET
88
What is the presentation difference between sporadic and familial Medullary thyroid carcinoma?
``` Sporadic = single nodule Familial = multiple b/l foci ```
89
Medullary thyroid carcinomas will stain + for?
Calcitonin
90
What can be seen deposited in the stroma in Medullary thyroid carcinomas?
Amyloid
91
What are the major Sx's of sporadic Medullary thyroid carcinoma?
Paraneoplastic syndrome (diarrhea due to VIP) and normal Ca levels
92
What is a useful tumor marker that is secreted in sporadic Medullary thyroid carcinoma?
Carcinoembryonic Ag (CAE)
93
Pts diagnosed with MEN 2B are often given _____ as prophylactic Tx for Medullary thyroid cancer?
Thyroidectomy
94
Morphology = cyst lined by stratified squamous epithelium in midline of neck
High-lying thyroglossal duct cyst
95
Morphology = cyst lined by epithelium resembling thyroidal acinar epithelium in midline of neck
Low-lying thyroglossal duct cyst

Zak, Endo/Repro 2 (33 decks)

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