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15 Endocrine > 15.3-7 Thyroid > Flashcards

15.3-7 Thyroid Flashcards

1
Q

Thyroid storm

-clinical presentation (3)

A
  1. arrhythmia
  2. hyperthermia
  3. vomiting with hypovolemic shock
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1
Q

How does thyroid hormone affect gut motility?

A

Low TH: constipation

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2
Q

Graves disease

-histology findings (2)

A
  1. irregular follicles (some with hyperplasia) with ‘scalloped colloid’
  2. chronic inflammation
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2
Q

Thyroid storm

-tx (3)

A

3 P’s

  1. propylthiouracil (blocks peroxidase and peripheral conversion of T4 to T3)
  2. Propranolol–beta blockers
  3. Prednisone–steroids
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2
Q

Medullary carcinoma, thyroid

  • proliferation of what cells?
  • clinical presentation
  • histology
A
  • prolifereation of parafollicular C cells (neuroendocrine cells, secrete calcitonin)
  • high calcitonin can lead to hypocalcemia

Histology: ‘localized amyloidosis’–Calcitonin often deposits within tumor as amyloid (pink). So, on FNA you see sheets of malignant cells in an amyloid stroma.

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3
Q

What are the 4 carcinomas to know that spread by blood, not lymph

A
  1. Renal cell carcinoma
  2. hepatic cell carcinoma
  3. follicular carcinoma
  4. choriocarcinoma
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4
Q

Follicular adenoma, thyroid

  • describe it
  • histology
A
  • benign proliferation of follicles surrounded by fibrous capsule (you see follicles within the tumor itself)
  • may secrete TH
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5
Q

Pt presents with a tender thyroid with signs of hyperthyroidism

  • think what?
  • ask what on history
A
  • subacute granulomatous (De Quervain) thyroiditis, follows a viral infection
  • produces transient hyperthyroidism and can progress to hypothyroidism (but usu self limiting)
  • ask about recent viral infection
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6
Q

Follicular carcinoma, thyroid

  • what is unique about its metastic spread?
  • gross appearance
A
  • it’s a carcinoma that spreads by blood instead of lymph (one of 4 to know)
  • malignant proliferation of follicles surrounded by fibrous capsule (just like adenoma) but with invasion through the capsule.
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7
Q

Cretinism

-symptoms (3)

A
  1. mental retardation
  2. short stature with skeletal abnormalities, coarse facial features, enlarged tongue
  3. umbilical hernia
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7
Q

what neoplasias?

MEN 1

MEN 2A

MEN 2B

A

PPP–pituitary, pancreatic endocrine, parathyroid

MPP–medullary thyroid, pheo, parathyroid

MPN–medullary thyroid, pheo, neuroma

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8
Q

MEN 2A and MEN2B

  • assoc with what genetics
  • inheritance?
A
  • RET mutation in MEN 2A and 2B (if you detect this, remove thyroid)
  • auto dom, “all MEN are dominant”
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9
Q

Graves disease

-Tx (3)

A
  1. beta blockers
  2. thioamid (blocks peroxidase)
  3. radioiodine ablation
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9
Q

Myxedema

  • symptoms based on what 2 general problems
  • characteristic (high yield) symptoms (2)
A

Term is synonymous with Hypothyroidism in older children, adults

  1. decreased basal metabolic rate
  2. decreased sympathetic activity

myxedema (accumulation of glycosaminoglycans in skin/soft tissue):

  1. deepening of voice
  2. large tongue
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9
Q

Hypothyroidism is called what in:

  1. infants, children
  2. older children, adults
A
  1. Cretinism
  2. Myxedema
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9
Q

Subacute Granulomatous (De Quervain) thyroiditis

  • cause
  • clinical presentation
A
  • granulomatous thyroiditis that follows a viral infection
  • presents as a tender thyroid with transient hyperthyroidism (De QuerVAIN–PAIN)
  • self-limited; 15% of time, progresses to hypothyroidism
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9
Q

Mother giving birth to child experiences hypovolemic shock, vomiting, arrythmias, hyperthermia.

-what to suspect?

A

Think thyroid storm, in women with Grave’s disease

-stress-induced catecholamine and hormone release

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11
Q

dyshormonogenetic goiter

-most common involves what enzyme

A
  • congenital defect in TH production
  • most commonly involves thyroid peroxidase
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12
Q

How does TH affect glucose levels?

A

TH increases gluconeogenesis, glycogenolysis

-so, hyperglycemia in hyperthyroidism

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12
Q

Graves disease

-lab findings (4)

A
  1. high total T4
  2. low TSH
  3. hypocholesterolemia
  4. hyperglycemia
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13
Q

Pt presents with nontender thyroid with throat obstruction.

-think what 2 things, and how to differentiate?

A

Think 2 things:

  1. Riedel fibrosing thyroiditis–patients are younger (40s), no malignant cells
  2. anaplastic carcinoma–patients are older
15
Q

Pt presents with thyroid nodule

-what test to do next to dx?

A
  1. 131 radioactive uptake study:
    - increased uptake (‘hot nodule’) is seen in Graves or nodular goiter
    - decreased uptake (‘cold nodule’) is seen in adenoma/carcinoma. Do biopsy! (FNA–fine needle aspiration)
16
Q

How are cholesterol levels affected by thyroid hormone?

-mech

A

increased TH increases LDL receptor expression, therefore lowering blood cholesterol.

16
Q

Multinodular goiter

  • cause
  • complication
A
  • enlarged thyroid gland with multiple nodules
  • due to relative iodine deficiency
  • Toxic goiter: rarely, regions can become TSH-independent, leading to T4 release and hyperthyroidism
18
Graves disease - what is a potentially fatal complication? - mech - when does it occur?
- Thyroid storm - elevated catecholamines and massive hormone excess, usu in response to stress (eg surgery, childbirth)
19
What thyroid congenital abnormalities? 1. mass at base of tongue 2. mass at anterior of neck
1. lingual thyroid 2. thyroglossal duct cyst
21
Cretinism -causes include (4)
1. iodine deficiency 2. maternal hypothyroidism during early pregnancy 3. thyroid agenesis 4. dyshormonogenetic goiter
23
Pt presents with thyroid mass and tetany, muscle spasms -think what
Medullary carcinoma--hypocalcemia from calcitonin release from parafollicular C cells
25
Hypothyroidism with tender thyroid vs nontender thyroid -think what?
- tender thyroid: subacute granulomatous (de quervain) thyroiditis - nontender: Riedel fibrosing thyroiditis ('hard as wood')
26
TH functions
4 B's Basal metabolic rate--increased B1-adrenergic--increased - Brain maturation - Bone growth--increased
28
Follicular carcinoma, thyroid - histology - what can it be confused with? and how to differentiate in that case?
- proliferation of follicles inside tumor, surrounded by fibrous capsule - histologically looks just like follicular adenoma - therefore, FNA cannot distinguish between the 2. Must examine the tumor grossly to see if there is invasion through the capsule (indicating follicular carcinoma)
29
1. thyroglossal duct cyst 2. lingual thyroid - clinical presentation (each)
1. anterior neck mass 2. mass at base of tongue
30
propylthiouracil - mech (2 effects) - tx for what
1. blocks peroxidase--(oxidation, organification, and coupling steps of TH synthesis) 2. peripheral conversion of T4 to T3 - block thyroid funcion (eg thyroid storm)
30
Riedel Fibrosing Thyroiditis - mech - clinical presentation
- chronic inflammation with extensive fibrosis of the thyroid gland - presents as nontender thyroid gland (hard as wood) with hypothyroidism - fibrosis may extend to involved local structures (eg airway)
31
Grave's disease - mech - classic population
- IgG stimulates TSH receptor (type 2 HSR) - women 20-40
32
Pt presents with a thyroid mass that is not painful, along with increasing difficulty eating and breathing -think what?
1. Riedel's fibrosing thyroiditis (mid age) 2. anaplastic carcinoma of thyroid (elderly) - differentiate by age. biopsy will reveal dx
34
Hashimoto's thyroiditis -histology (3 things)
1. chronic inflammation 2. germinal centers 3. Hurthle cells (pink--eosinophilic metaplasia of cells that line follicles)
35
Exophthalmos and Pretibial myxedema: -mech
- seen in Grave's disease - fibroblasts behind orbit and in shin have TSH receptors and react to IgG against TSH - TSH actvation leads to glycosaminoglycan deposition, leading to edema ('dough like' consistency)
36
Hashimoto's thyroiditis - clinical symptoms - TH lab levels - what Ab?
- presents initially as hyperthyroidism (due to follicle damage) - progresses to hypothyroidism (low T4, high TSH) 1. antithroglobulin Ab 2. antithyroid peroxidase Ab
37
Pt initially presents with signs of hyperthyroidism, then now with signs of hypothyroidism -think what?
1. Hashimoto's thyroiditis--can present initially with hyperthyroidism b/c of follicle damage--release of TH 2. also think De Quervain's thyroiditis--presents with transient hyperthyroidism and can progress (rarely) to hypothyroidism
38
Grave's disease -clinical symptoms (3)
1. hyperthyroidism 2. diffuse goiter 3. exophthalmos, pretibial myxedema ('dough like' consistency) - fibroblasts behind orbit and overlying the shin express TSH receptor. TSH activation results in glycosaminoglycan buildup
39
What to do if you suspect MEN in your pt?
- test for RET mutation (for MEN 2A/2B) - if positive, remove thyroid gland prophylactically to prevent medullary carcinoma
41
Papillary carcinioma, thyroid -histology (3)
Papillae lined by cells with 1. 'Orphan Annie eye' nuclei (empty, white nuclei) 2. nuclear grooves 3. Papillae also have psammoma bodies (Ca+ layering
42
Papillary carcinoma, thyroid - prevalence among thyroid carcinoma - assoc with what major risk factor
- most common thyroid carcinoma (80%) - exposure to ionizing radiation in childhood (classic: pt had face/neck irradiated as child for acne)
44
What is the specific biopsy procedure for thyroid?
FNA--fine needle aspiration -needle must be thin, as thyroid bleeds easily
45
Thyroid cancer: - all malignant types (4) - nonmalignant type (1) - which is most common
PFA-M all carcinomas: Papillary (80%) Follicular Anaplastic Medullary -follicular adenoma (benign)
47
Thyroglossal cyst -etiology, embryology
- cystic dilation of thyroglossal duct remnant - thyroid develops at base of tongue, then travels along the thyroglossal duct to anterior neck - thyroglossal duct normally involutes; however, a persistent duct can undergo cystic dilation
48
Toxic goiter
- rare complication of multinodular goiter, caused by iodine deficiency - rarely, nodules can become TSH-independent and secrete T4
49
Hashimoto's thyroiditis - assoc with what genetics - increased risk for what complication
- HLA DR5 - increased risk of B cell lymphoma (presents as enlarging thyroid gland late in Hashimoto's disease course)
50
Anaplastic carcinoma, thyroid - what is it, population - prognosis - clinical presentation
- undifferentiated malignant tumor, usu in elderly - poor prognosis, highly malignant - presents similar to Riedel's fibrosing thyroiditis--nontender thyroid mass that invades local anatomy. can cause dysphagia or respiratory compromise
51
Myxedema (hypothyroidism) - most common causes (2) - other causes include (2)
1. Hashimoto's thyroiditis 2. iodine deficiency 1. drugs (eg lithium) 2. surgery/radioablation
52
Papillary carcinioma, thyroid -prognosis
excellent. survival \>95% often spreads to cervical lymph nodes

15 Endocrine (7 decks)

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