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305 Patho > Thyroiditis > Flashcards

Thyroiditis Flashcards

1
Q

Thyroiditis, or inflammation of the thyroid gland,
encompasses a diverse group of disorders
characterized by some form of thyroid inflammation.

A

• (1) Hashimoto thyroiditis
• (2) Granulomatous (de Quervain) thyroiditis
• (3) Subacute lymphocytic thyroiditis

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2
Q

HASHIMOTO THYROIDITIS (struma lymphomatosa) is a …. Disease

A

autoimmune

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3
Q

Consequence of HASHIMOTO

A

destruction of the thyroid gland and gradual and
progressive thyroid failure

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4
Q

The most common cause of hypothyroidism in areas of the world where ….. levels are sufficient

A

iodine

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5
Q

HASHIMOTO THYROIDITIS

Ages

A

between 45 and 65 years of age

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6
Q

HASHIMOTO THYROIDITIS
Gender

A

More common in women than in men( a female predominance of
10:1 to 20: 1.)

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7
Q

HASHIMOTO THYROIDITIS causes …in the pediatric population

A

nonendemic goiter

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8
Q

HASHIMOTO THYROIDITIS is cused by

A

Autoantibodies to thyroglobulin and thyroid
peroxidase(+)

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9
Q

What may cause Autoantibodies to thyroglobulin and thyroid peroxidase(+) in HASHIMOTO THYROIDITIS

A

. Abnormalities of regulatory T cells (Tregs) -
cytotoxic T lymphocyte-associated antigen-4 (CTLA4)
and protein tyrosine phosphatase-22 (PTPN22)
• Exposure to normally sequestered thyroid
antigens

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10
Q

HASHIMOTO THYROIDITIS gross

A

➢ Diffuse enlargement ➢ Intact capsule ➢

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11
Q

Cut surface if hoshimoto thyroiditis

A

pale, yellow-tan, firm, and somewhat nodular

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12
Q

HASHIMOTO THYROIDITIS LM

A

➢ A mononuclear inflammatory
infiltrate (small lymphocytes, plasma cells)
➢ Well-developed germinal centers
➢ Increase in interstitial connective tissue.

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13
Q

fibrosis does not extend
beyond the capsule of the
gland in … but it does in…

A

HASHIMOTO THYROIDITIS
Reidel thyroiditis,

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14
Q

3 types of follicles in hashimoto thyroiditis

A

1.atrophied with no colloid
3.thyroid lined with hurthle cells
3.lymphoid follicles with germinal center formation

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15
Q

HASHIMOTO THYROIDITIs mainly affects

A

Middle-aged women

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16
Q

Clinical HASHIMOTO THYROIDITIS

A

Painless thyroid enlargement (symmetrical and widespread)

• Hypothyroidism ( gradually): T4 and T3 levels ↓, TSH↑

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17
Q

In some patients, thyroid hormones are released suddenly with…… and … may develop

A

disruption of thyroid follicles
transient thyrotoxicosis (“hashitoxicosis”)

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18
Q

In transient thyrotoxicosis (“hashitoxicosis”)
Free T4 and T3 levels … TSH… and radioactive iodine uptake …

A

↑,

↓,

↓,

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19
Q

Hashimoto thyroiditis increases the risk for

A

extranodal marginal zone B-cell lymphomas
within the thyroid gland

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20
Q

SUBACUTE LYMPHOCYTIC (PAINLESS) THYROIDITIS
Is most commonin

A

middle-aged adults and women

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21
Q

SUBACUTE LYMPHOCYTIC (PAINLESS) THYROIDITIS
Manifests as

A

Mild hyperthyroidism and goiter enlargement of the gland

22
Q

Painless thyroiditis and postpartum thyroiditis are variants of

A

autoimmune thyroiditis:

23
Q

autoimmune thyroiditis is caused by

A

Antithyroid peroxidase antibodies Family history of other autoimmune diseases

24
Q

1/3 of cases of SUBACUTE LYMPHOCYTIC (PAINLESS) THYROIDITIS

A

Hypothyroidism, histology like Hashimoto

25
Q

SUBACUTE LYMPHOCYTIC (PAINLESS) THYROIDITIS
Clinical

A

Slightly symmetrical enlargement of the thyroid gland,
usually normal size
Painless goiter, transient overt hyperthyroidism, or both
• Transition from hyperthyroidism to hypothyroidism

26
Q

SUBACUTE LYMPHOCYTIC (PAINLESS) THYROIDITIS LM

A

Lymphocytic infiltration with large germinal centers within the thyroid parenchyma and patchy disruption and collapse of thyroid follicles

27
Q

GRANULOMATOUS THYROIDITIS (De Quervain thyroiditis)
Age

A

The ages of 40 and 50

28
Q

GRANULOMATOUS THYROIDITIS (De Quervain thyroiditis)
Gender

A

Affects women considerably more often than men (4:1)

29
Q

GRANULOMATOUS THYROIDITIS (De Quervain thyroiditis)

Trigger

A

Viral infection

Upper respiratory infection

30
Q

Seasonal incidence of GRANULOMATOUS THYROIDITIS (De Quervain thyroiditis)

A

Peak in summer

31
Q

Associated viruses

A

coxsackievirus, mumps, measles, adenovirus, and other viral infections (+)

32
Q

GRANULOMATOUS THYROIDITIS (De Quervain thyroiditis) causes….
….is effective in this damage.

A

tissue damage.

secondary viral antigen or thyroid antigen stimulating cytotoxic T lymphocytes which damage follicle cells

33
Q

Difference of GRANULOMATOUS THYROIDITIS (De Quervain thyroiditis) from autoimmune thyroid disease:

A

➢ The immune response is
initiated by the virus
➢ Does not continue on its
own
➢ Process is limited

34
Q

GRANULOMATOUS THYROIDITIS (De Quervain thyroiditis) gross

A

➢ Unilateral or bilateral thyroid gland
enlargement ➢ Hard yellow-white thyroid gland -
adheres to surrounding tissue

35
Q

Histological changes in GRANULOMATOUS THYROIDITIS (De Quervain thyroiditis)
differ according to

A

the stage of the disease.

36
Q

Histo Initial GRANULOMATOUS THYROIDITIS (De Quervain thyroiditis)

A

Follicular disruption and microabscesses

37
Q

Advanced stage: GRANULOMATOUS THYROIDITIS (De Quervain thyroiditis)
Histo

A

Plasma cells associated with damaged thyroid follicles, multinuclear giant cells (surround naked colloid pools or fragments)

38
Q

Late stage: GRANULOMATOUS THYROIDITIS (De Quervain thyroiditis)
Histo

A

Chronic inflammation and fibrosis

39
Q

GRANULOMATOUS THYROIDITIS (De Quervain thyroiditis) clinical

A

• Pain
• Thyroid enlargement
• Transient inflammation and hyperthyroidism (ends in 2-6 weeks even without treatment)
• Hypothyroidism
• Time to return to normal thyroid function with recovery: 6-8 weeks

40
Q

in granulomatius T3,T,TSH, iodine

A

( T3 T4⬆️ TSH ↓), radioactive iodine uptake↓
Hyperthyroidism

41
Q

RIEDEL THYROIDITIS

A

Extensive fibrosis involving the thyroid and contiguous neck structures

42
Q

Riedel manifests as

A

Diffuse, stony, and painless goiter

43
Q

RIEDEL THYROIDITIS
Age

A

Between 30-50 years old

44
Q

Gender reidel thyroiditis

A

Female to man ratio:4:1

45
Q

.. clinically mimics thyroid carcinoma.

A

RIEDEL THYROIDITIS

46
Q

RIEDEL THYROIDITIS
may be associated with fibrosis in other sites in the body
Like

A

(retroperitoneal and mediastinal fibrosis, sclerosing cholangitis,
pancreatitis

47
Q

RIEDEL THYROIDITIs manifestes as

A

Initial euthyroid, then hypothyroid

48
Q

RIEDEL THYROIDITIS is another manifestation of

A

a systemic autoimmune IgG4-related
disease

49
Q

LM OF RIEDAL

A

Lymphocytes, plasma cells(IgG4), a few eosinophils, neutrophil infiltration Extensive fibrosis, extraglandular involvement

50
Q

Differential diagnosis:
Of riedal

A

Sjögren Lymphoma Anaplastic carcinoma

305 Patho (1 decks)

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