thyroid II

Question 1

cretinism

Answer 1

hypothyroidism in neonates and infants
causes mental retardation, short stature with skeletal abnormalities, coarse facial features, enlarged tongue, umbilical hernia

Question 2

causes of cretinsim

Answer 2

maternal hypothyroidism in early pregnancy
thyroid agenesis
dyshomonogenetic goiter: most common enzyme deficiency is thyroid peroxidase
iodine deficiency

Question 3

What is myxedema

Answer 3

hypothyroidism in older kid or adult
dough-like edema (increased glycosaminoglycans)
deepened voice and enlarged tongue
decr. basal metolic rate and decr. sympathetic activity
weight gain, normal appetite, slowed mental activity, muscle weakness, cold intolerance, bradycardia w/ decr. output, oligomenorrhea, hypercholesterolemia, constipation

Question 4

causes of myxedema

Answer 4

iodine deficiency, hashimoto thyroidits, lithium, surgical removal or radio ablation

Question 5

Hashimoto’s thyroiditis

Answer 5

associated with HLA-DR5 and an increased risk of non-Hodgkin lymphoma (esp. marginal zone lymphoma)
autoimmune destruction of thyroid. typically, it involves anti-thyroid peroxidase antithryoglobulin antibodies, antimicrosomal antibodies. Dr. Sattar says that these do not mediate the disease.

Question 6

clinical features of hashimoto’s

Answer 6

initially presents with hyperthyroid, but then they get hypothyroidism (during destruction, hormone leaks out, but as they destroy the tissue, they eventually get hypothyroid).
T4 down, TSH up.
antithyroglobulin and antimicrosomal abs present- signs of thyroid damage
thyroid will be moderately enlarged and NON-TENDER

Question 7

histo of hashimotos

Answer 7

chronic inflammation with formation of germinal centers (incr. risk of marginal zone lymphoma)
Hurthle cell change: pink cells in the thyroid.

Question 8

diseases associated w/ hashimotos’ thyroidits

Answer 8

incr risk of B cell lymphoma

Question 9

subacute granulomatous thyroiditis

Answer 9

after a viral infection
granulomatous inflammation with transient hyperthyroidism
presents as a TENDER thyroid, incr. ESR, jaw pain.
does NOT progress to hypothyroidism

Question 10

Reidel’s fibrosing thyroiditis

Answer 10

chronic inflammation with extensive fibrosis of the thyroid. hypothyroid.
presents as a hard as wood, non-tender thyroid gland
fibrosis may extend to local structures like the airway.
considered a manifestation of IgG4-related systemic disease.
you would worry about anaplastic carcinoma as part of your differential, but anaplastic carcinoma is a disease of older people, while Reidel’s is usually a younger patient.