Thyroid Pathology Dwight Asseinheimer

Question 1

what cells are present in the thyroid?

Answer 1

Parafollicular cells “clear cells”
Cuboidal follicular cells
Sinusoidal capillaries
Colloid

Question 2

What is a goitre?

What are some common causes?

Answer 2

Any swelling in the throat region caused by enlargement of the
thyroid gland.
Causes: inflammation neoplasia
hyperplasia hypertrophy

Question 3

What are the macro/micro features of a diffuse non toxic goitre?

Answer 3

Macroscopic: Hyperplastic, Colloid
Microscopic: flattened/cuboidal, Colloid

Question 4

Causes of inflammation of the thyroid

Answer 4

• Acute thyroiditis
• Hashimoto’s disease
• De Quervain’s disease
• Subacute Lymphocytic thyroiditis 
• Chronic thyroiditis •
 Granulomatous thyroiditis 
• Riedel’s disease

Question 5

Acute thyroiditis- causes?

Answer 5

Caused by bacterial infection via hematogenous pathway or direct inoculation from nearby infection.
Pyogenic micro-organisms like Staphylococcus spp are the most common causes.
Small abscesses may resolve without damage to the gland.

Question 6

What is Hashimoto’s thyroiditis?

What is the pathogenesis?

What is the morphology?

Answer 6

Autoimme hypothyroidism
Pathogenesis:
1. Humoral & Cellular Immunity
2. Viral/Bacterial initiation?

Morphology:

1. Diffuse enlargement
2. Preserved capsule
3. Mononuclear inflammatory infiltrate (Hürthle cells) HURTHLE CELLS
4. Increased connective tissue

Question 7

If you gave someone with Hashimoto’s iodine , what would happen?

Answer 7

DECREASED IODINE UPTAKE

Question 8

De Quervain’s disease

Answer 8

Idiopathic, T-Lymphocytes (cytotoxic) attack follicular cells

Question 9

Macroscopic/microscoic features of De Quervain;s

Weird clinical features–??

Answer 9

macroscopic:
unilateral/bilateral enlargement
hard consistency
yellow-white areas on visual inspection
microscopic:
patchy changes: - acute inflammatory infiltrate - mononuclear infiltrate
collapsed and damaged follicles.

Transient hyperthyroidism (2-6 wk) followed by hypothyroidism

Question 10

What is Reidel’s disease?

what are the clinical symptoms?

Answer 10

fibrotic thyroiditis

Tracheal entrapment: chocking feeling dyspnoea, cough
Oesophageal compression: dysphagia
Nerve compression: (recurrent laryngeal nerve paralysis), hoarseness dysphonia aphonia

Question 11

What are the clinical manifestations of hypothyroidism?

Answer 11

Clinical Manifestation:
• Cretinism – children
• Juvenile – in children with adult characteristics • Myxoedema -adult

Question 12

What are the causes of cretinism?

Answer 12

1. Congenital:
   - due to hypoplasia/aplasia of the thyroid; goitre is not present autosomal-recessive trait expressed by enzymatic defects, with goitrous gland due to excessive TSH production
2. Endemic: high altitude regions, poor iodine in the soil (Himalayas, Andes, Alps)
   2 forms:
   - myxoedematous (similar to adult) + mental and physical growth retardation
   neurological – mental deficiency, deaf-mute, spasticity and incoordination

Question 13

What is myxoedema?

Answer 13

Severe hypothyroidism but can also occur in Graves disease (hyperthyroidism)
Skin changes

Question 14

3 common causes of hyperthyroidism

Answer 14

1. Functional adenoma
2. Toxic multinodular goitre
3. Diffuse hyperplasia (Graves’s disease a.k.a Graves- Basedow’s Disease and Basedow’s disease) resultant from an abnormal thyroid stimulator

Question 15

What are the causes of Grave’s disease?

Answer 15

Causes :
TSH auto-antibodies:
- Thyroid-stimulating Immunoglobulin
- Thyroid Growth-stimulating Immunoglobulins = - TSH-binding Inhibitor Immunoglobulins

Triggers: molecular mimicry? primary T-cell autoimmunity, infiltrative ophthalmopathy (autoimmune?)

Question 16

In graves would you get increased or decreased radioiodine uptake?
Would TSH be increased or decreased

Answer 16

INCREASED iodine

TSH decreased

Question 17

How would you come to a definitive conclusion of nodule being neoplastic?

Answer 17

FNA biopsy and histological studies

Question 18

Distinguish simple adenoma from a colloid adenoma

Answer 18

Simple Adenoma:
Very similar to normal thyroid tissue
Great variation in the size of thyroid follicles A common type of adenoma

Colloid Adenoma:
Follicles are very large in size and distended Contain large quantities of colloid
Common occurrence

Question 19

What are the risk factors for tumour?

Answer 19

risk factors include age (the younger higher is the chance of neoplasia),
gender (male), and history of radiaQon