DIT XVI: Endocrine

Question 1

Name given to thyroid hormone-secreting teratoma

Answer 1

Struma ovarii

Question 2

S&S of hypothyroidism

Answer 2

wt gain, cold intolerance, constipation, lowering of voice, menorrhagia, slowed mental & physical fxn, dyr skin with coarse brittle hair, reflexes showing slow return ohase, facial/periorbital myxedema

Question 3

Myxedema of hyper vs hypothyroidism

Answer 3

Hyperthyroidism: pretibial myxedema
Hypothyroidism: facial/periorbital myxedema

Question 4

Rx for hypothyroidism

Answer 4

Levothyroxine (synthetic T4 analogue), triiodothyronine (T3)

Question 5

Causes of cretinism

Answer 5

Iodine-deficient diet (in mom or baby). thyroid-related enzyme def, thyroid develop’tl defect, failure of thyroid descent, transfer of anti-thyroid Abs during gestation

Question 6

Clinical findings in congenital hypothyroidism

Answer 6

Cretinism = “6 P’s”: Pot-bellied, Pale, Puffy-faced, Protruding umbilicus, Protuberant tongue, Poor brain develop’t

Question 7

Painless vs painful goitre

Answer 7

Painless: Hashimoto’s thyroiditis, Riedel’s thyroiditis
Painful: Subacute (de Quervain) thyroiditis

Question 8

Dx test for Hashimoto’s thyroiditis

Answer 8

antithyroglubulin, antithyroid peroxidase Abs

Question 9

Genes assoc with Hashimoto’s thyroiditis

Answer 9

HLA-DR5, HLA-B5

Question 10

What cancer is associated with Hashimoto’s thyroiditis

Answer 10

B-cell lymphoma

Question 11

What diseases are associated with Hashimoto’s thyroiditis?

Answer 11

DM, pernicious anemia, Sjogrens

Question 12

Most common type of thyroid cancer

Answer 12

Papillary carcinoma

Question 13

Second most common type of thyroid cancer

Answer 13

Follicular carcinoma

Question 14

Thyroid cancer assoc with activation of receptor tyrosine kinases

Answer 14

Papillary and medullary carcinomas

Question 15

Cancer arising from parafollicular C cells

Answer 15

Medullary carcinoma

Question 16

Thyroid cancer commonly assoc with either RAS mutation or PAX8-PPAR gamma I rearrangement

Answer 16

follicular carcinoma

Question 17

Thyroid cancer commonly assoc with rearrangments in RET oncogene or NTRKI

Answer 17

papillary carcinoma

Question 18

Thyroid cancer associated with mutation in BRAF gene (serine/threonine kinase)

Answer 18

papillary carcinoma

Question 19

MOA of propylthiouracil (PTU)

Answer 19

Inhibits peroxidase and 5’-deiodinase: blocks addition of iodide onto tyrosine groups of thyroglobulin, decreases periph conversion of T4 –> T3

Question 20

ADRs of propylthiouracil and methimazole

Answer 20

rash, agranulocytosis, aplastic anemia

Question 21

MOA of methimazole

Answer 21

Inhibits peroxidase: blocks addition of iodide onto tyrosine groups of thyroglobulin

Question 22

Risk factor for subacute (de Quervain) thyroiditis

Answer 22

recent viral infection: cocksackievirus, measles, mumps, etc

Question 23

Findings in subacute (de Quervain) thyroiditis

Answer 23

painful goitre, fever, focal destruction with granulomatous inflammation, raised ESR

Question 24

Findings in Riedel’s thyroiditis

Answer 24

Macrophages, eosinophils, painless goitre, fibrous tissue that can extend into airway (can mimic anaplastic carcinoma)

Question 25

"Orphan Annie eye"

Answer 25

empty appearing nucleus, associated with papillary carcinoma of thyroid

Question 26

Histological findings in papillary carcinoma of thyroid

Answer 26

"Orphan Annie eye", psammoma bodies, nuclear grooves

Question 27

Risk factors for papillary carcinoma of thyroid

Answer 27

RET & BRAF mutations, childhood irradiation, NTRK1

Question 28

Follicular carcinoma vs follicular adenoma of thyroid

Answer 28

Carcinoma: invades thyroid capsule Adenoma: doesn't go through fibrous capsule

Question 29

Mode of spread of follicular carcinoma of thyroid

Answer 29

Hematogenous spread

Question 30

Risk factors for follicular carcinoma of thyroid

Answer 30

RAS mutation, PAX8-PPAR gamma 1 mutation

Question 31

Findings in medullary carcinoma of thyroid

Answer 31

increased calcitonin, sheets of cells in amyloid stroma

Question 32

Risk factors for medullary carcinoma

Answer 32

MEN2A & 2B (RET mutations)

Question 33

Complications of thyroidectomy

Answer 33

Damage to parathyroid glands (decr Ca2+) and recurrent laryngeal nerve (hoarseness)

Question 34

Enlarged thyroid cells with ground glass appearance

Answer 34

"Orphan Annie" eye nuclei (papillary carcinoma)