26. Hypothyroidism Flashcards Preview

Endocrine > 26. Hypothyroidism > Flashcards

Flashcards in 26. Hypothyroidism Deck (60):
1

MCC of hypothyroidism in iodine -sufficient regions

HAshimoto thyroiditis

2

HAshimoto thyroiditis - pathophysiology

autoimmune disease disorder
antibodies : 1. thyroid peroxidase ( antimicrosomal)
2. antithyroglobulin

3

HAshimoto thyroiditis is associated with ( predisposition)

HLA -DR5

4

HAshimoto thyroiditis increases the risk of

non- Hodgkin lymphoma

5

HAshimoto thyroiditis - thyroid appearance ( clinical )

1. moderately enlarged
2. non tender thyroid

6

HAshimoto thyroiditis -course

may be hyperthyroid early in course due to thyrotoxicosis during follicular rupture
then hypothyroid

7

HAshimoto thyroiditis - histology

1. Hurthle cells
2. lymphoid aggregate with germinal centers

8

HAshimoto thyroiditis - cells

Hurthle cells

9

cretinism also called

congenital hypothyroidism

10

congenital hypothyroidism ( cretinism ) is

severe fetal hypothyroidism

11

congenital hypothyroidism is due to

1. maternal hypothyroidism
2. thyroid agenesis
3. thyroid dysgenesis ( MCC in US)
4. iodine deficiency
5. dyshormogenetic goiter

12

congenital hypothyroidism - findings

6P s
1. Pot belly
2. pale
3. poor brain development
4. puffy - faced child
5. protruding umbilicus
6. protuberant tongue

13

congenital hypothyroidism - findings - ORGANS

1. belly
2. brain
3. face
4. umbulicus
5. tongue
6. skin (pale)

14

congenital hypothyroidism ( cretinism) - belly

pot belly

15

congenital hypothyroidism ( cretinism) - face

puffy faced and protuberant tongue

16

congenital hypothyroidism ( cretinism)

protuberant tongue

17

congenital hypothyroidism ( cretinism)

protruding umbilicus

18

subacute thyroiditis is also called

de QUERVAIN

19

subacute thyroiditis (de QUERVAIN ) - histology

granulomatous inflammation

20

subacute thyroiditis (de QUERVAIN ) - course

may be hyperthyroid early in course, followed by hypothyroidism

21

subacute thyroiditis (de QUERVAIN ) - treatment

self limited

22

subacute thyroiditis (de QUERVAIN ) - often following

a flu like illness

23

subacute thyroiditis (de QUERVAIN ) - findings

1. increased ESR
2. jaw pain
3. ear;y onflammation
4. VERY TENDER THRYOID

24

subacute thyroiditis (de QUERVAIN ) - special feature

VERY TENDER THYROID

25

subacute thyroiditis (de QUERVAIN )- lab

increased ESR

26

Reidel thyroiditis - histology

thyroid replaced by fibrous tissue with inflammatory infiltrated

27

Reidel thyroiditis - findings / thyroid hormones?

fixed - hard ( rock like), PAINLESS goiter
1/3 are hypothyroid

28

Reidel thyroiditis can mimic ..... why

anaplastic carcinoma
fibrosis may extend to local structures ( eg fibrosis

29

Reidel thyroiditis - consider the manifestation of

IgG4- related systemic disease ( eg autoimmune pancreatitis , noninfenctious aotitis , retroperitoneal fibrosis)

30

Wolf - Chaikoff effect

thyroid gland downregulation in response to increased iodine

31

causes of hypothyroidism

1. Hashimoto
2. Cretinism
3. de Quervain
4. Riedel thyroditis
5. idione deficienct
6. goitrogens
7. Wolff chakodd effect

32

causes of goiter are divided to

1.smouth / diffuse
2. nodular

33

causes of nodular goiter

1. toxic multinodular
2. thyroid adenoma
3. thyroid cancer
4. thyroid cyst

34

causes of Smouth / diffuse goiter

1. graves disease
2. hashimoto thyroiditis
3. iodine deficiency
4. TSH secreting pituitary adenoma

35

goitrogens are

substances ( whether in drugs, chemicals, or foods( that disrupt the production of thyroid hormones by interfering with iodine uptake in the thyroid gland

36

thyroid disorder with increase ALP

thyroid stom

37

thyroid disorder with jaw pain

de Quervain

38

thyroid disorder that often following a flu like illness

de Quervain

39

thyroid disorder that is life threatening

thyroid stom

40

toxic multinodular goiter is also called

plammer disease

41

toxic multinodular goiter under IODINE SCAN

see hot nodules

42

dyspnea on exertion : hyper: or hypo thyoidism

hypothyroidism

43

MCC of cretisnism in USA

thyroid dysgenesis

44

thyrotoxic myopathy ?

proximal muscle weakness with normal CK

45

hypothyroid myopathy?

proximal muscle weakness with increased CK

46

graves histology

tall, crowded follicular epithelial cells, salloped colloid

47

brittle hair - hyper vs hypothyroidism

hypothyroidism

48

thyrotoxic vs hypothyroid myopathy

both proximal muscle weakness
thyrotoxic --> normal CK
hypothyroid--> increased CK

49

goitrens substance

1. amiodarone
2. lithium

50

exopthalmus on Graves mechanism

infiltration of retroorbital space by activated T- cells --> increased cytokine ( eg TNF - α , iFN - γ ) --> fibroblast secretion of hyydrophilic GACs --> osmotic muscle swelling, muscle inflammation, and adipocyte count --> exopthalmus

51

A man presents with weight gain, decreased appetite, and a moderately enlarged, nontender thyroid. What is the most likely pathophysiology?

Hashimoto thyroiditis (most common hypothyroidism); autoimmune disorder caused by anti-thyroglobulin antibodies and associated with HLA-DR5

52

A patient has a thyroid biopsy showing Hürthle cells and lymphocytes with germinal centers. What other disease is she at risk for?

Non-Hodgkin lymphoma, the risk of which is increased by Hashimoto thyroiditis

53

You are doing a pediatrics rotation in an area with dietary iodine deficiency. What symptoms suggest cretinism in a newborn?

6 P's: Pot-bellied, Pale, Puffy-faced, Protruding umbilicus, Protuberant tongue, Ppoor brain development

54

A man with a recent cold presents with jaw pain and a tender thyroid. His erythrocyte sedimentation rate is high. Treatment?

None, as subacute thyroiditis (de Quervain) is a self-limited hypothyroidism that may be hyperthyroid early in its course

55

Following a cold, a man briefly has symptoms of hyperthyroidism, followed by self-limited hypothyroidism. What do you see on histology?

Subacute thyroiditis has granulomatous inflammation with giant cells on histology

56

A patient has weight gain, constipation, and cold intolerance. On exam, his thyroid is hard and painless. Describe the pathophysiology.

Riedel thyroiditis is caused when the thyroid is replaced by fibrous tissues (a manifestation of IgG4-related systemic disease)

57

You biopsy a thyroid gland for concern of malignancy. Histology shows extensive collagen deposition. What is highest on your differential?

Riedel thyroiditis—thyroid replaced by fibrous tissue (and may extend to local structures), mimicking anaplastic carcinoma

58

A woman cannot tolerate heat after having the flu. A week later, she reports cold intolerance but notes that it is improving. Diagnosis?

Subacute thyroiditis (de Quervain): self-limited hypothyroidism following a flu-like illness that may be hyperthyroid early in its course

59

You biopsy a thyroid and diagnose anaplastic carcinoma. Later, you find that it is really due to IgG4-related systemic disease. Diagnosis?

Riedel thyroiditis (can be mistaken for anaplastic carcinoma of the thyroid)

60

• A patient presents with a painful thyroid gland. Labs show elevated ESR, physical exam shows jaw pain. What will thyroid biopsy show?

Granulomatous inflammation (this is subacute thyroiditis [de Quervain])