7: Pathology of the Thyroid - Fang

Question 1

primary v. secondary v. tertiary hyperthyroidism

Answer 1

1- the thyroid gland is over-functioning

2- the gland is hyperfunctioning because it is being overstimulated by TSH, reflecting a primary problem in pituitary gland

3- too much TSH because there is too much hypothalamic TRH

Question 2

weight loss, muscle atrophy, heat intolerance, increased appetite, sweat

Answer 2

hyperthyroidism

Question 3

lid lag indicates what

Answer 3

graves disease

delay in downward movement of the upper eyelid as the patient looks down

Question 4

thyroid storm

Answer 4

development of extreme hypermetabolissm leading to coma and death

Question 5

graves disease

Answer 5

high T3 and T4, low TSH

autoimmune with antibody directed against TSH receptor bidning domain

Question 6

what causes proptosis/exophtalmos ?

Answer 6

• lid lag
• weak eye muscles
• excess collagen and ground substance behind the eyeball

Question 7

pretibial myxedema with nodules

Answer 7

hyperthyroidism - graves disease

Question 8

diffuse, symmetrical beefy red gland =

Answer 8

grave’s disease

Question 9

pale colloid with resorption vacuoles “scalloping” and hyperplastic follicles with papillary infoldings

Answer 9

graves disease histology

Question 10

risk for hypothyroidism

Answer 10

down syndrome patients

Question 11

facial and periorbital edema, enlarged tongue, coarse dry skin, laterally truncated eyebrows, decreased metabolism

Answer 11

hypothyroidism

Question 12

generalized myxedema without nodules

Answer 12

hypothyroidism

Question 13

hypothyroidism presenting first in infancy or childhood

Answer 13

cretinism

stunted growth, retarded mental development, altered eyebrows, puffy eyelids

Question 14

when must cretinism be treated?

Answer 14

thyroid hormone must be replaced before the 3rd week

Question 15

deficiency is regulatory T cells and increase in cytotoixic T cells and activated b cells

Answer 15

hashimoto thyroiditis

Question 16

diffusely enlarged pale, yellow-tan, firm thyroid

Answer 16

hashimoto thyroiditis

Question 17

hurthle cells

Answer 17

hashimoto thyroiditis

Question 18

painful, transient thyroiditis secondary to viral infection

Answer 18

de quervain thyroiditis

Question 19

thyroid’s ability to produce thyroid hormone is impaired –> increased TSH

Answer 19

goiter

due to low iodide

Question 20

neoplasm v. multinodular goiter

Answer 20

no capsule with goiter

colloid goiter –> multinodular goiter

Question 21

“cold nodules”

Answer 21

palpable mass lesions that fail to take up radiolabeled iodine — most likely malignant tumor

Question 22

“hot nodules”

Answer 22

palpable mass lesions that are hyperfunctioning and accumulated increased amounts of radioiodine relative to surrounding normal during a scan

Question 23

thyroid adenoma?

Answer 23

not malignant

solitary, spherical encapsulated lesion that is demarcated from the surrounding thryroid parenchyma by a well-defined, intact capsule

Question 24

decreasing order of prevalence- thyroid cancers = 
papillary
follicular
medullary
anaplastic

Answer 24

medullary and anaplastic least prevalent and most deadly

Question 25

orphan annie eyes =

Answer 25

papillary thyroid carcinoma

also see fibrovascular stalk with tumor cells, psammoma bodies, nuclear hole inclusions, coffee bean nucleus

Question 26

coffee bean nucleus =

Answer 26

papilalry thyroid carcinoma

Question 27

to where to follicular thyroid carcinomas metastasize?

Answer 27

lungs and bone

uses vascular route of invasion

Question 28

very, very ugly, both histologically and clinically

Answer 28

anaplastic carcinoma of the thyroid (undifferentiated)