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Pance Re-Up > Endocrine #4 (Thyroiditis and Thyroid Cancer) > Flashcards

Endocrine #4 (Thyroiditis and Thyroid Cancer) Flashcards

1
Q

Hashimoto’s Thyroiditis AKA _________, is the MCC of hypothyroidism in the US.

Explain the pathophysiology of this

A

-Chronic Lymphocytic Thyroiditis

-Autoimmune thyroid cell destruction by anti-thyroid peroxidase and anti-thyroglobulin antibodies

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2
Q

How do you differentiate Hashimoto’s Thyroiditis from other thyroiditis diseases?

The patients with this condition usually have what symptoms?

A

It is usually paired with another autoimmune disease (Sjogren’s, MG, Celiac, Addison’s)

Symptoms of hypothyroidism. Enlarged, nontender thyroid/goiter, neck/throat tightness.

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3
Q

What is the treatment for Hashimoto’s Thyroiditis?

A

Levothyroxine (synthetic T4)
-Synthroid

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4
Q

Subacute Thyroiditis AKA (Granulomatous, Dequervain, Giant Cell) Thyroiditis, is thought to be caused by a _______.

What is it associated with (gene defect)

A

Antecedant viral respiratory tract infection or post-viral inflammation

HLA-B35

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5
Q

What is the presentation of a patient with subacute thyroiditis (not symptoms, just what do the diagnostics show?)

A

-Hyperthyroidism followed by euthyroidism, then hypothyroidism, then restoration of normal thyroid function

-It changes as time goes by

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6
Q

Symptoms of subacute thyroiditis

A

-Painful thyroid gland worse with head movements and swallowing
-Acute pain that radiates to the jaw and ear
-Low grade fever, myalgias, fatigue, malaise
-Diffusely tender goiter!

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7
Q

What do labs show for subacute thyroiditis (think about what should be negative, and what an infection does)

A

-High ESR + negative thyroid antibodies

-Hyperthyroid early in disease (decreased TSH + increased T4)

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8
Q

On radioactive uptake scan for subacute thyroiditis, what is expected?

A

Diffuse, decreased iodine uptake (much like Hashimoto’s and Postpartum Thyroiditis)

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9
Q

On biopsy for subacute thyroiditis, what is seen?

A

Granulomatous inflammation with multinucleated giant cells

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10
Q

Treatment for subacute thyroditis

A

-Supportive: reassurance because 95% return to euthyroid state
-NSAIDs, Aspirin for pain
-Prednisone if needed for severe pain

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11
Q

Postpartum thyroiditis occurs in 4-7% of women in what time frame after delivery?

Often, this condition is ______

A

In the first six months after delivery

Painless!

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12
Q

Often postpartum thyroiditis’ cause is due to _________ and what is present on labs that you should remember?

A

Autoimmune

+ Thyroid antibodies: thyroglobulin antibodies, thyroid peroxidase antibodies (like Hashimoto’s)

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13
Q

Treatment for postpartum thyroidits

A

-Supportive: Aspirin, NSAIDs

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14
Q

Reidel Thyroiditis, is a rare chronic autoimmune thyroiditis characterized by dense fibrosis that invites the thyroid and adjacent neck structures. What is secreted in this condition?

A

IgG4-secreting plasma cells

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15
Q

On clinical presentation for Reidel Thyroiditis, what symptoms do you get?

A

Hypothyroidism Symptoms
-Presents like thyroid malignancy: rock hard, nontender, rapidly growing, fixed goiter
-Compression Symptoms: hoarseness, dysphagia, choking, coughing, increased RR due to airway compression
-NO CERVICAL LAD

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16
Q

What diagnostics are done for Reidel Thyroiditis?

A

-Increased TSH + decreased T4/T3 (euthyroid or hypothyroid)
-IgG4 serum levels

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17
Q

What diagnostic should you do to distinguish anaplastic thyroid cancer from Reidel Thyroiditis?

A

Biopsy

18
Q

What is seen on biopsy for Reidel Thyroiditis?

A

-Dense fibrosis

19
Q

Treatment for Reidel Thyroiditis

A

-Surgical treatment to reduce compression

20
Q

What is suppurative thyroiditis?

Who does it MC occur in?

A

-bacterial infection of thyroid gland by Staph Aureus

MC occurs in children, but rare

21
Q

Symptoms of suppurative thyroiditis

A

-Thyroid pain and tenderness: sudden neck pain and tenderness. Worse with hyperextension and better with neck flexion
-Overlying erythema of the skin
-Fever, chills, pharyngitis, dysphagia, hoarseness

22
Q

What diagnostics are done for suppurative thyroiditis?

A

-Labs: Leukocytosis, increased ESR (due to infection)
-FNA with gram stain and culture
-Thyroid US

23
Q

Treatment for suppurative thyroiditis

A

-ABX
-Surgical drainage if fluctuant

24
Q

The only two causes of a painful thyroid are ______ and _______

A

Subacute Thyroiditis and Suppurative Thyroiditis

25
Q

What is an acronym to remember the thyroid cancers in order from MOST common/LEAST aggressive to LEAST common/MOST aggressive?

A

PFMA

Paul Fucked My Ass

26
Q

MC type of Thyroid Cancer?

It is MC in what population?

A

Papillary Carcinoma

Women

27
Q

Where does metastasis for papillary carcinoma usually occur?

A

Local (Cerivcal lymph nodes MC)

28
Q

How do Papillary, Follicular, and Medullary thyroid cancers present?

A

Painless thyroid nodule

29
Q

Papillary thyroid cancer has risk factors such as

A

-After radiation exposure
-Family history of thyroid cancer
-Smoking!
-Females***
-30-60 year old

30
Q

What diagnostic is usually done for a workup of thyroid cancer?

A

Thyroid US
FNA

31
Q

Treatment for papillary thyroid cancer

A

-Thyroidectomy and then post-op Levothyroxine

32
Q

Follicular thyroid cancer is a little more aggressive that papillary thyroid cancer. What is one risk factor that is specific to this type that you should remember?

A

Iodine deficiency

33
Q

Also, what should you remember about METS with follicular carcinoma?

A

Follicular goes FAR

-Distant METS more common than local METS (hematogenous spread): lung MC, liver, brain, bone

34
Q

Treatment for follicular carcinoma

A

-Thyroidectomy with post-op Levothyroxine
-Radioactive iodine to ablate any remaining tissue

35
Q

Follicular carcinoma can secrete enough T4 to cause a ______

A

Thyroid Storm

36
Q

Medullary Thyroid Cancer, which makes up 3% of all thyroid cancers, is derived from

It should be remembered that 1/3 is associated with what genetic defect?

A

-Calcitonin-synthesizing parafollicular C cells

MEN IIa or IIb (RET mutation)

37
Q

For this reason, what do labs show for medullary thyroid cancer?

A

Increased Calcitonin

38
Q

Treatment for medullary thyroid cancer

A

-Total thyroidectomy
-Radioactive iodine to ablate any tissue

39
Q

The most aggressive type of thyroid cancer is _________

What symptoms does this one have.

A

-Anaplastic Thyroid Cancer

-Rapid growth, compressive symptoms, dyspnea, dysphagia

40
Q

What does the thyroid feel like in anaplastic thyroid cancer?

A

Rock hard thyroid mass, may be fixed

41
Q

Treatment for anaplastic thyroid cancer

A

-Most are not amenable to surgical resection
-Radiation or chemotherapy
-Palliative tracheostomy to maintain airway

42
Q

Anaplastic thyroid cancer is MC in what population?

A

Elderly (>65)

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