7.26 Thyroid 2

Question 1

mechanism of goiter

Answer 1

• iodine deficiency
• impaired thyroid hormone synthesis
• compensatory increase TSH
• follicle cell hypertrophy and hyperplasia
• increase colloid
• enlarged gland

Question 2

euthyroid (started out hypo) patient with enlarged gland and no nodules, maybe some visual changes

• diagnosis
• labs

Answer 2

diffuse nontoxic goiter

normal T3, T4, TSH normal or increased

Question 3

patient from himalayas with large goiter

• type of goiter
• causes

Answer 3

endemic goiter

• deficient dietary iodine
• goitrogens (foods that inhibit thyroid hormone synthesis such as cabbage and sweet potato)

Question 4

young female with goiter

• type of goiter

Answer 4

sporadic goiter

Question 5

multinodular goiter caused by

Answer 5

recurrent hyperplasia and involution

Question 6

morphologic phases of goiters

Answer 6

hyperplastic

• mild enlargement
• small follicles
• few colloid

colloid involution

• if iodine increases or demand for thyroid hormone decreases
• enlarged
• follicles large with flat epithelium
• colloid abundant

Question 7

symptoms of goiter compression

Answer 7

airway obstruction

dysphagia

SVC syndrome

Question 8

hyperactive nodule (releases thyroid) + goiter

• diagnosis

Answer 8

Plummer syndrome / toxic multinodular goiter

Question 9

ways to rule out thyroid malignancy

Answer 9

FNA

possible resection

Question 10

young male patient with one nodule more likely to be benign or malignant

Answer 10

malignant

Question 11

functional “hot” nodules that take up radioactive iodine more likely to be benign or malignant

Answer 11

benign

Question 12

solitary encapsulated mass without capsular or vascular invasion is

Answer 12

follicular adenoma

Question 13

mass without capsule is

Answer 13

goiter

Question 14

mass with capsular or vascular invasion

Answer 14

carcinoma

Question 15

uniform, monomorphic cells that contain colloid

Answer 15

follicular adenoma

Question 16

cells with abundant eosinophilic cytoplasm and uniform cells

Answer 16

Hurthle cell adenoma (a type of follicular adenoma)

Question 17

most common thyroid carcinoma

Answer 17

papillary carcinoma

Question 18

pathogenesis of thyroid carcinoma

Answer 18

• radiation 0-20 yo (acne, nuclear)

- deficient iodine (follicular carcinoma)

Question 19

Orphan Annie eyes

Answer 19

papillary thyroid carcinoma

Question 20

nuclear grooves

Answer 20

papillary thyroid carcinoma

Question 21

intranuclear inclusions

Answer 21

papillary thyroid carcinoma

Question 22

psammoma bodies

Answer 22

papillary thyroid carcinoma

Question 23

activated MAP kinase pathway

Answer 23

papillary thyroid carcinoma

Question 24

genetic mutations of papillary thyroid carcinoma

Answer 24

rearranged RET genes

rearranged NTKR (neurotrophic tyrosine kinase receptor 1)

point mutation in BRAF

Question 25

treatment for papillary thyroid carcinoma, follicular carcinoma

Answer 25

thyroidectomy radioactive iodine thyroid replacement

Question 26

55 year old woman from himalayas has slow growing, painless mass in neck. Histo shows capsular and vascular invasion - diagnosis - prognosis

Answer 26

follicular carcinoma prig based on invasion and stage of diagnosis

Question 27

activated PI-3K pathway

Answer 27

follicular carcinoma

Question 28

genetic mutations of follicular carcinoma

Answer 28

t(2;3) gain of function RAS amplify PIK3CA loss of function PTEN

Question 29

t(2;3) causes

Answer 29

follicular carcinoma

Question 30

65 year old female with a history of thyroid carcinoma has a rapidly enlarging mass with wide mets, can't talk, coughs a lot - diagnosis - prognosis

Answer 30

anaplastic thyroid carcinoma fatal in less than 1 year

Question 31

bizarre cells with mitoses

Answer 31

anaplastic thyroid carcinoma

Question 32

mutation in RET proto-oncogene

Answer 32

papillary thyroid carcinoma medullary thyroid carcinoma

Question 33

solid growth without CT capsule, parafollicular C cells of thyroid secreting calcitonin, with necrosis and hemorrhage - diagnosis - types

Answer 33

medullary thyroid carcinoma sporadic (70%) 1 lobe and familial (30%) bilateral

Question 34

neuroendocrine cells amongst amyloid

Answer 34

medullary thyroid carcinoma

Question 35

positive for congo red stain

Answer 35

medullar thyroid carcinoma (b/c it stains amyloid)

Question 36

familial medullary thyroid carcinoma associated with

Answer 36

MEN2A and 2B

Question 37

thyroid migration begins in

Answer 37

foramen cecum (at back of tongue)

Question 38

patient with midline mass. told to stick out her tongue, which made the mass move - diagnosis - cause - complications

Answer 38

thyroglossal duct/cyst persistent sinus tract infections cause abscesses

Question 39

ectopic thyroids can be in what locations

Answer 39

lingual (tongue) substernal