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Year 2 Endocrine > Thyroid Pathology > Flashcards

Thyroid Pathology Flashcards

1
Q

If the thyroid fails to descend from it embryological origin what is this called?

A

Linguinal thyroid

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2
Q

If the thyroid undergoes excessive descent where is it most likely to be located?

A

Retrosternal within the mediastinum

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3
Q

What are some non autoimmune causes of thyroiditis?

A

Palpation
Subacute lymphocytic infiltrate
Infection

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4
Q

What is autoimmune hypothyroidism usually due to?

A

Hashimoto thyroditis

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5
Q

What is autoimmune hyperthyroidism usually due to?

A

Graves disease

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6
Q

What are some causes of hyperthyroidism?

A

Hyper-functioning Nodules or tumours

Graves disease

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7
Q

Graves Disease

A

10F:1M 20-40years

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8
Q

What causes the hyperthyroidism in graves disease?

A

Thyroid stimulating immunoglobulin

Acts independently of T3, T4 as well as TSH so isn’t inhibited

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9
Q

Graves disease clinical signs

A

Diffuse thyroid enlargement
Eye changes - bulging eyes
Pretibial Myxoedema

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10
Q

Why are specific tissues affected in graves disease?

A

As fibroblasts express TSH recpetors

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11
Q

What is the definition of hypothyroidism?

A

Low T3 and T4 levels

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12
Q

Hashimotos thyroditis

A

Middle age women

HLA DR3 / DR5

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13
Q

What can also cause hypothyroidism?

A

Iodine deficiency

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14
Q

What antibodies are associated with Hashimotos thyroiditis?

A

Antithyroglobulin

Anti Peroxidase

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15
Q

What does the presence of antibodies in hypothyroidism result in?

A

Antibody dependant cell mediated cytotoxicity

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16
Q

What to look for in hashimotos thyroiditis?

A 
Diffusely enlarged thyroid
Prominent lymphoid infiltrate
Follicle atrophy 
Eosinophilic cytoplasm
Possible fibrosis
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17
Q

What can precede hashimotos thyroiditis?

A

Transient hyperfunction - Hashitoxicosis

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18
Q

What are those with hashimotos thyroiditis at an increased risk of?

A

B cell Non-Hodgkins Lymphoma

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19
Q

What is a goitre?

A

Any enlargement of the thyroid gland

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20
Q

What is the most common cause of goitre?

A

Lack of iodine

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21
Q

Why does a reduced iodine level result in a goitre?

A

As iodine deficiency results in low T3 and T4
Causes increase in TSH
Stimulates enlargement of the gland in effort to restore T3 and T4 levels

22
Q

Endemic reasons for diffuse goitre

A

Iodine deficiency or ingestion of goitregenic substances

23
Q

Sporadic reasons for diffuse goitre

A

Inborn errors in metabolism - Dyshormonogenesis
F>M
Most cases are iatrogenic

24
Q

What does lab analysis of blood samples in goitre usually show?

A

T3/T4 normal

TSH high

25
Q

What is an adenoma of the thyroid called?

A

Follicular adenoma

26
Q

What are the four main carcinomas of the thyroid called?

A

Papiliary
Follicular
Medullary
Anaplastic

27
Q

Which is the most common carcinoma?

A

Pappiliary 75-85%

28
Q

How do follicular adenomas clinically appear?

A

Discrete solitary nodule
Often incidental finding
Produce local symptoms e.g. dysphagia hoarse voice

29
Q

Under the microscope how do follicular adenomas appear?

A

Neoplastic thyroid follicles

Encapsulated by surrounding collagen cuff

30
Q

Why do adenomas usually produce no systemic symptoms?

A

As they are usually non functional

- some can secrete hormones causing thyrotoxicosis

31
Q

What carcinoma is related to iodine deficiency?

A

Follicular carcinoma

32
Q

What carcinoma is related to ionising radiation?

A

Papillary carcinoma

33
Q

Papilliary genetics

A

MAP kinase pathway activated and RAS mutation

34
Q

Follicular genetics

A

P13k/AKT pathway

35
Q

Anaplastic genetic

A

p53 and beta catenin mutation

36
Q

Medullary genetics

A

Familial link

MEN2 mutation

37
Q

Papilliary carcinoma

A

Usually a solitary nodule but can be multi nodular

- often cystic or calcified

38
Q

Papilliary carcinoma symptoms

A

Hoarseness dysphagia cough dysopnea - locally advanced

39
Q

How is a papillary carcinoma usually spread?

A

Lymphatic metastasis

40
Q

If a papillary carcinoma is haemotgenously spread where does it usually presen?

A

Lung

Indicates very late stage

41
Q

Prognosis in papillary carcinoma

A

10 year survival is 95%

42
Q

Follicular carcinoma

A

Slowly enlarging painless and non functional single nodule

43
Q

What is main form of metastasis in follicular carcinoma?

A

Haematogenous

Bones Lungs and Liver

44
Q

When is a follicular carcinoma difficult to distinguish from an adenoma?

A

When its minimally invasive and well differentiated

45
Q

Prognosis of an follicular carcinoma?

A

10 year survival is 50%

46
Q

Where is a medullary thyroid carcinoma derived from?

A

Neuroendocrine C-cells

47
Q

What are common systemic affects of medullary thyroid carcinoma?

A

Diarrhoea VIP production

Cushings syndrome ACTH production

48
Q

What to look for in medullary thyroid tumour?

A

Congo red stian - amyloidosis

C cell hyperplasia

49
Q

What mutation indicates familial link and more aggressive potential?

A

MEN2B

50
Q

Anaplastic

A

Undifferentiated and aggresive
Rapid growth and invasion of local neck structures
High mortality
Older patients

Year 2 Endocrine (21 decks)

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