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SBCP Pathology > Endo: Thyroid Disease > Flashcards

Endo: Thyroid Disease Flashcards

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1
Q

True/false: Thyroid develops embryologically from laryngeal epithelium

A

False, develops from pharyngeal epithelium and descends in neck

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2
Q

Why does ectopic thyroid tissue occur?

A

Thyroid descends down neck as it develops

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3
Q

Weight of thyroid

A

15-20g

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4
Q

Thyroid receives nerve supply from ____ _____ nerves

A

cervical sympathetic

Influences thyroid secretion by acting on blood vessels

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5
Q

Thyroid follicles are surrounded by___ epithelium

The centre of the follicle contains ____ which stores the thyroid hormone

A

Thyroid follicular epithelium

Colloid

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6
Q
  1. ___ released by pituitary after action of THRH from hypothalamus
  2. TSH acts on thyroid to release __ and lesser amounts of ___
A
  1. TSH

2. T4, lesser amounts of T3

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7
Q

T3 and T4 are reversibly and loosely bound in circulation to ________

A

Thyroxine binding globulin TBG

Maintains level of free T3 and T4 within narrow limits

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8
Q

What is a multinodular goitre?

A

NON NEOPLASTIC, common disorder, presents later in life

Progressive cycle of hyperplasia followed by degeneration and fibrosis. Gland becomes enlarged and nodular

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9
Q

Multinodular goitre: A degenerate process of ______ and regression.

A

Hyperplasia

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10
Q

Histology: Cystic change within follicles so they are dilated and filled with colloid. Surrounded by fibrosis. Gland shows architectural nodularity and is overall enlarged

A

Multinodular goitre

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11
Q

Most common causes of hyperthyroidism? (3)

A

Diffuse toxic hyperplasia (Graves) (85%)

Toxic multinodular goitre

Toxic adenoma

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12
Q

Uncommon causes of hyperthyroidism

A

Thyroiditis

Exogenous thyroxine or TSH

Secreting pituitary adenoma

Neonatal thyrotoxicosis

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13
Q

Cardiac and MSK clinical features of hyperthyroidism

A

Overactivity of SNS

Tachycardia
Palps.
Arrhythmia
Congestive HF

Atrophy of MSK tissues
OSTEOPOROSIS

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14
Q

Neuromuscular clinical features of hyperthyroidism

A

Tremor
Hyperactivity
Anxiety
Irritability

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15
Q

Skin and GI clinical features of hyperthyroidism

A

Warm skin
Sweating

Increased appetite
Weight loss
Increased bowel mobility

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16
Q

How is hyperthryoidism diagnosed?

A

Free levels of T4 in peripheral blood

TSH level will be suppressed

Radioactive iodine uptake will be increased

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17
Q

Causes of hypothyroidism

A

Radiation/surgery
HASHIMOTO THYROIDITIS

Idiopathic primary hypothyroidism (blockade of TSH receptors)

Iodine deficiency
Drugs (lithium, iodides)

Pituitary or hypothalamus lesions lowering TSH or TRH

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18
Q

Hypothyroidism in infancy:

___ in iodine deficient areas.

Poor development of ____ and ___ along with mental retardation

A

Endemic

Skeleton, CNS

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19
Q

Another name for hypothyroidism

A

Myxoedema

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20
Q

Clinical features of adult hypothyroidism (myxoedema)

A 
Decreased sweating
Constipation
Weight gain
Feeling cold
Accumulation of matrix substances in subcut. tissue

Slowing of physical/mental activity
Depression

LOW CARDIAC OUTPUT-SOB, decreased exercise tolerance

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21
Q

Diagnosis of hypothyroidism

A

Difficult clinically

Decreased T3, T4

Raised TSH

**NB pituitary or hypothalamic causes may have low TSH

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22
Q

Reidel’s thyroiditis

A

Progressive fibrous replacement of the thyroid tissue

Causes hypothyroidism

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23
Q

Palpation thyroiditis

A

Histological changes due to pre-operative handling or palpation of tissue

Hypothyroidism

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24
Q

Gross changes seen in Hashimotos thyroiditis

A

Symmetrical atrophy of thyroid tissue

Hypothyroidism

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25
Hashimotos thyroiditis: Histology features are ____ tissue and epithelial ___ cell change (oncocytic cells)
Lymphoid Pink
26
Histology: The thyroid epithelial cells also show a characteristic change. They have abundant eosinophilic, or pink cytoplasm, and this is known as oncocytic, or Hurthle cell metaplasia.
Hashimoto's thyroiditis
27
What is most common cause of thryoiditis?
Hashimoto's thyroiditis
28
Pathology of Hashimoto's thyroiditis
Autoimmune disease due to defect in T cells (cellular and humoural immunity) Activation of thyroid specific CD4 cells and CD8 cytotoxic cells B cells secrete anti TSH factors HYPOTHYROIDISM
29
High prevalence of HLA DR3 and DR5 in which thyroid disease?
Hashimoto's thyroiditis
30
Who gets Hashimoto's thyroiditis?
F:M is 15:1 | Typically 45-65
31
Presentation of Hashimoto's thyroiditis?
Painless thyroid enlargement
32
What diseases are linked to Hashimoto's thyroiditis?
Increased incidence of B cell lymphoma of thyroid Associated with other auto-immune diseases
33
What are the specific manifestations of Grave's disease?
Infiltrative opthalmopathy: Immune mediated infiltration of periocular muscles and soft tissue Pretibial myxoedema
34
Age range affected by Grave's disease?
20-40 years | Mostly females
35
HLA B8 and DR3 linked to which thyroid disease
Grave's
36
Pathology of Grave's disease
TSH receptor autoantibodies mimic TSH and stimulate thyroid hormone production
37
Lab findings in Grave's disease
Raised free T3 and T4, TSH decreased
38
Histology: Diffuse tightly packed hyperplastic follicles with pseudopapillae. Involves both lobes. No nuclear features
Grave's
39
What percentage of cancers are made up of malignant thyroid cancers?
1%
40
Populations most affected by thyroid cancer
Younger adults | Females more than men
41
Features suggestive of thyroid cancer (3)
Solitary nodule Enlarged nodes Nodule in YOUNGER PT
42
Thyroid adenoma: Discrete solitary mass derived from ____ epithelium
Follicular
43
Thyroid adenoma: Shares architectural features with follicular cancer except has an intact surrounding ____-
capsule
44
Which type of thyroid mass has these histological subtypes? Microfollicular Macrofollicular Oncocytic (Hurthle cell)
Thryoid adenoma
45
True/false: There is no vascular invasion associated with a follicular adenoma
True
46
Risk factors for thyroid malignancy
NB: Most cases are sporadic Ionising radiation Genetic factors (eg Cowden syndrome, FAP, familial PTC syndrome) MEN syndrome- medullary carcinoma
47
Which thyroid cancer is linked to MEN syndrome?
Medullary carcinoma | Multiple endocrine neoplasia syndrome
48
4 subtypes of thyroid carcinoma?
Papillary (80%) Follicular (10%) Medullary(5%) Anaplastic(<5%)
49
Most common subtype of thyroid cancer?
Papillary carcinoma
50
Age range affected by papillary carcinoma
20-40 years
51
Papillary carcinoma metastases %?
10-15%
52
10 year survival rate of papillary carcinoma
98%
53
Mechanism of follicular carcinoma metastasis?
Blood-borne route
54
Mechanism of papillary carcinoma metastasis?
Via lymph nodes
55
Difference between follicular carcinoma and adenoma?
Carcinoma breaches the capsule and/OR invades the BVs
56
Medullary carcinoma: _____ carcinoma derived from parafollicular __ Cells- sheets, nests or trabeculae of small dark cells
Neuroendocrine C Cells
57
Which hormone is secreted by medullary tumours that can aid diagnosis?
Calcitonin
58
Stromal change associated with medullary carcinoma?
Pink amyloid deposition
59
What percentage of medullary carcinomas are inherited?
Up to 25% Associated with MEN 2A and 2B and familial MTC (medullary thyroid carc.) syndrome
60
5 year survival rate of medullary carcinoma
80% but may metastasis early
61
Which main thyroid cancer subtype is undifferentiated?
Anaplastic carcinoma (pleomorphic or spindled tumour cells)
62
Mortality of anaplastic carcinoma?
90-100%!!!
63
How does anaplastic carcinoma spread?
Rapid extensive local infiltration of the neck
64
What is a poorly differentiated carcinoma?
Tumour which is intermediate morphologically between a differentiated thyroid tumour and an undifferentiated one (anaplastic) True follicles or well formed papillae are not the main feature of these tumours
65
5 year survival of poorly differentiated carcinoma
50%
66
Thyroid lymphoma: May complicate _____. Usually ___ cell and low grade
Thyroiditis B

SBCP Pathology (24 decks)

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