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Hormonal & Reproductive Week 1 - WLB > Thyroid Pathology - Krafts > Flashcards

Thyroid Pathology - Krafts Flashcards

1
Q

What two effects does TSH have on the thyroid?

A

Thyroid growth and Hormone synthesis

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2
Q

What are the two thyroid lab tests are the most important?

A

TSH and T4

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3
Q

Labs in Primary Hyperthyroidism?

A

High T4 + Low TSH

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4
Q

Labs in Secondary or Tertiary Hyperthyroidism?

A

High T4 + High TSH

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5
Q

Labs in Primary Hypothyroidism?

A

Low T4 + High TSH

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6
Q

Labs in Secondary or Tertiary Hyperthyroidism?

A

Low T4 + Low TSH

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7
Q

Labs in Subclinical Hyperthyroidism?

A

Normal T4 + Low TSH

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8
Q

Labs in Subclinical Hypothyroidism?

A

Normal T4 + High TSH

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9
Q

What are the other less common/less important thyroid lab tests?

A

Free T3

Antibody tests => anti-peroxidase Ab (Hashimoto), anti-thyroglobulin Ab (Hashimoto/Grave’s), anti-TSH receptor Ab (Grave’s)

Radioiodine scanning

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10
Q

What kind of problems give rise to Primary, Secondary, and Tertiary Hyperthyroidism/Hypothyroidism?

A

1°: thyroid problem

2°: pituitary problem

3°: hypothalamic problem

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11
Q

What are the signs and symptoms of Hyperthyroidism?

A

General: weight loss, heat intolerance

Cardiac: rapid pulse, arrhythmias

Neuromuscular: tremor, emotional lability

Skin: warm, moist

Gastrointestinal: diarrhea

Eye: lid lag (eye lid does not move with eye movement due to increased sympathetic stimulation of ocular muscles)

Thyroid storm: extreme, dangerous symptoms

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12
Q

What are the common and uncommon causes of Hyperthyroidism?

A

Common: Graves disease, Multinodular goiter, Thyroid adenoma

Uncommon: Thyroiditis, Drugs, Thyroid carcinoma, Pituitary adenoma, Struma ovarii (hamartoma on ovary), Factitous (taking thyroid hormone to lose weight)

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13
Q

What are the signs and symptoms of Hypothyroidism?

A

General: fatigue, weight gain, cold intolerance

Cardiac: slow pulse, impaired contraction

Nervous: delayed reflexes, lethargy

Skin: rough, dry; hair loss (outer 1/3 of eyebrows)

Gastrointestinal: reduced appetite, constipation

Myxedema: deepened voice, “edema” (firm ground substance in any tissues)

Myxedema coma: deteriorating mental status

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14
Q

What are the causes of Congenital Hypothyroidism?

A

iodine deficiency, genetic problems

Tx with thyroid hormone replacement

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15
Q

What are the common and uncommon causes of Acquired Hypothyroidism?

A

Common: Hashimoto, Iatrogenic

Uncommon: Goiter
Infiltrative stuff
Too much iodine
2° hypothyroidism
3° hypothyroidism
Other thyroiditis
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16
Q

What are the four types of Thyroiditis?

A
  1. Hashimoto Thyroiditis (Mrs. Potatohead)
  2. DeQuervain Thyroiditis (Rex)
  3. Silent Thyroiditis (Bullseye)
  4. Reidel Thyroiditis (Woody)
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17
Q

What is Hashimoto Thyroiditis?

A

Autoimmune disease of thyroid (genetic predisoposition)

Painless, big thyroid

F»M

Eventual hypothyroidism

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18
Q

How do you diagnose Hashimoto Thyroiditis?

A

Thyroid function tests:
The usual 1° hypothyroidism findings(Low T4 + High TSH)

Anti-thyroid antibody tests:
Anti-peroxidase antibodies

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19
Q

What unique cells can be seen in Hashimoto Thyroiditis?

A

Hurthle Cells

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20
Q

What are the T-cell and B-cell consequences in Hashimoto Thyroiditis?

A

T cells are screwed up:
don’t recognize own thyroid antigens!, attack thyroid, stimulate B cells

B cells are unwitting accomplices
anti-TSH-receptor antibody, anti-thyroglobulin antibody, anti-peroxidase antibody

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21
Q

How does DeQuervain Thyroiditis present?

A

Big, sore thyroid => follicles burst open and release T3/T4
Recent URI
Suddenly/Early, hyperthyroidism
Self-limiting

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22
Q

What is the pathogenesis of DeQuervain Thyroiditis?

A

Viral infection initiates.

Antigen causes an increase in CD8 cells.

Damaged follicles leak colloid.

Foreign-body giant cell reaction ensues.

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23
Q

How does Silent Thyroiditis present?

A

Post-partum or middle age.

Painless, slightly enlarged thyroid.

Mild hyperthyroidism early on.

24
Q

How does Reidel Thyroiditis (fibrosing thyroiditis) present?

A

Rare!
Rock-hard neck mass (feels like a stone)
Hypothyroidism
Tracheal compression

25
Q

What is the most common cause of hyperthyroidism in the US?

A

Grave’s Disease

F>M

26
Q

What three symptoms in the classic triad of Grave’s Disease?

A

Hyperthyroidism
Ophthalmopathy (exophthalmous, retro-orbital tissues)
Dermopathy (pre-tibial fibroblasts, thickening/discoloration of pre-tibial region)

27
Q

What lab tests are used to diagnose Graves Disease?

A
28
Q

What does the microscopic appearance of Graves Disease look like?

A

epithelial proliferation, papillae and scalloped colloid

29
Q

What is the pathogenesis of Graves Disease?

A

anti-TSH-receptor antibodies

=> follicular cell proliferation => thyroid gets big

=> thyroid hormone release => sx of hyperthyroidism

30
Q

What causes a Goiter? Pathogenesis?

A

Inflammatory (thyroiditis) or non-inflammatory (defective T4 synthesis)

defective enzymes/kale/cabbage/no iodine/? => ↓T4 => ↑TSH => Gland grows => GOITER!

31
Q

What is the difference between a simple goiter and multinodular goiter?

A

Simple = enlarged thyroid

Multinodular = cycles of hyperplasia and involution of thyroid tissue with fibrous deposition

32
Q

How do Thyroid neoplasms present?

A

Most neoplasms present as nodules.

Nodules are common!

Most are benign.

Thyroid carcinoma is uncommon.

33
Q

What pt circumstances are more likely to be thyroid cancer?

A

It’s more likely to be cancer if:

  • Patient is male
  • Nodule is solitary
  • Nodule is cold
  • There is a history of radiation
34
Q

What test can be done to take a small sample of the thyroid?

A

Thyroid fine needle aspiration

35
Q

What is the clinical presentation/clinical findings in a patient with Thyroid Adenoma?

A

Common!

Most patients are euthyroid, Some hyperthyroid

36
Q

What tests do you use to Dx a Thyroid Adenoma?

A

TSH and T4 usually normal

Radioiodine scan => Most adenomas “cold”

37
Q

What is the morphology of Thyroid Adenomas?

A

Solitary
Encapsulated
No invasion

38
Q

What are the unique genetic characteristics of Thyroid Adenomas?

A

May have G-protein mutation

Gain-of-function mutation

39
Q

Why do you remove Thyroid Adenomas even though they are benign neoplasms?

A

Adenoma can look like carcinoma. Need to see whole capsule to tell the two apart.

40
Q

What is the most common type of malignant Thyroid Carcinoma? Next common?

A

Papillary

Then follicular, medullary, and anaplastic

41
Q

What type of malignant Thyroid Carcinoma has the best prognosis?

A

Papillary => Excellent prognosis (>95% 10y survival)

42
Q

What patient population is Papillary Thyroid Carcinoma most common in?

A

F > M, 30s-50s

43
Q

Where are the most common locations of metastases in Papillary Thyroid Carcinoma?

A

Local lymph node metastasis common

Visceral metastasis rare

44
Q

What is the morphologic appearance of Papillary Thyroid Carcinoma?

A 
“Trees with branches”
Orphan Annie nuclei
psammoma bodies
pseudoinclusions
nuclear grooves (look like coffee beans)
45
Q

Why is Papillary Thyroid Carcinoma considered “The Little Orphan Annie Tumor”?

A

Often affects younger women

Tends to stay around for years => without getting any bigger

Is usually well-behaved; seldom kills people

Has nuclei that resemble Orphan Annie’s eyes

Has psammoma bodies (from the greek psammos, or sand) => Annie’s dog is named Sandy

46
Q

What patient population are Follicular Thyroid Carcinomas most common in?

A

F > M, 40s-50s

47
Q

What is the prognosis of Follicular Thyroid Carcinomas?

A

Mets, if present, are in lung or bone

95% 10y survival in young patient with small, minimally invasive tumor

Prognosis worsens with increasing age, tumor size, and invasiveness

48
Q

What patient population are Medullary Thyroid Carcinomas most common in?

A

F>M, 50s-60s

49
Q

What is Medullary Thyroid Carcinoma a malignancy of?

A

Uncommon malignancy of C cells

Sporadic (most) or familial

50
Q

What is the prognosis of Medullary Thyroid Carcinoma?

A

90% 10y survival if confined to thyroid

20% 10y survival if distant mets are present

51
Q

What does the morphology of Medullary Thyroid Carcinoma look like under microscope?

A

Amyloid deposition => pink bubble gum stretched out
Amyloid is apple green with Congo red stain

Salt & Pepper chromatin nuclei

52
Q

What is the clinical presentation of Medullary Thyroid Carcinoma?

A

Rare
F>M, 50s-60s
Bulky, fast-growing, invasive neck mass
Usually metastatic at diagnosis

53
Q

What is the prognosis of Medullary Thyroid Carcinoma?

A

Very bad prognosis (

54
Q

What is the clinical presentation of Anaplastic Thyroid Carcinoma?

A

Rare
F>M, 50s-60s
Bulky, fast-growing, invasive neck mass
Usually metastatic at diagnosis

55
Q

What is the prognosis of Anaplastic Thyroid Carcinoma?

A

Very bad prognosis (

Hormonal & Reproductive Week 1 - WLB (13 decks)

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