Flashcards in ENT Deck (440)
A. Age group.
A. Middle-aged women.
B. Thyroidal tenderness, fever, sore throat, malaise.
Granulomatous thyroiditis: Hormonal status.
Initial phase: T4 and T3 often elevated.
Resolution: Usually euthyroid, but can be hypothyroid.
Granulomatous thyroiditis: Histology (3).
Foreign-body granulomas centered on follicles.
Giant cells with ingested colloid; neutrophils early; mononuclear cells.
Granulomatous thyroiditis vs. sarcoidosis.
Sarcoidosis: Granulomas are in the interstitium rather than centered on follicles.
Granulomatous thyroiditis vs. fungal thyroiditis.
Fungal thyroiditis: Usually acute inflammation with necrosis; granulomas are less frequent.
Granulomatous thyroiditis vs. Hashimoto's thyroiditis.
- Germinal centers.
- Oncocytic change.
Granulomatous thyroiditis vs. palpation thyroiditis.
- Fewer giant cells and mononuclear cells within thyroid follicles.
- No neutrophils.
B. Associated HLA types.
A. Areas with abundant iodine.
B. DR3, DR5.
Hashimoto's thyroiditis: Associated genetic diseases (3).
Familial Alzheimer's disease.
Hashimoto's thyroiditis: Pitfalls in diagnosis (2).
Parasitic nodules may be confused with nodal metastases.
Optically clear nuclei may be overdiagnosed as papillary thyroid carcinoma.
Hashimoto's thyroiditis: Lymphocytes.
Mixture of B and T cells.
Hashimoto's thyroiditis vs. nonspecific lymphocytic thyroiditis (3).
Nonspecific lymphocytic thyroiditis:
− Fewer germinal centers.
− No oncocytic change.
− Minimal fibrosis.
A. Age group.
B. Associated fibrosing disorders (3).
A. Peak in the fifth decade.
B. Mediastinal fibrosis; retroperitoneal fibrosis; sclerosing cholangitis.
Riedel's thyroiditis: Inflammation.
Lymphocytes, plasma cells, neutrophils, histiocytes, eosinophils.
No giant cells, no germinal centers.
Riedel's thyroiditis: Vascular change.
"Occlusive phlebitis": Lymphocytes and plasma cells cause thickened wall and myxoid change.
Riedel's thyroiditis vs. undifferentiated thyroid carcinoma.
The carcinoma contains scattered malignant cells; IHC may help.
A. Corticosteroids or tamoxifen; surgery as needed.
B. Hypothyroidism in half of cases.
Graves' disease: Associated HLA types.
Histology of Graves' disease:
B. After treatment with radioactive iodine.
A. Hyperplastic thyroid follicles with decreased colloid; variable lymphocytic inflammation.
B. Nuclear atypia, stromal fibrosis, more colloid.
A. Location of amyloid.
B. Other histologic features (2).
A. Around vessels and between thyroid follicles.
B. Squamous metaplasia, secondary atrophy of follicles.
Dyshormogenetic goiter: Most common functional defect.
Inability to incorporate iodine.
Dyshormogenetic goiter: Most commonly associated malignancy.
Dyshormogenetic goiter: Gross appearance.
Enlarged, nodular thyroid gland.
Dyshormogenetic goiter: Histologic architecture (2).
Small follicles contain scant colloid and form clusters that are separated from one another by fibrous bands.
Follicular cells may form papillae.
Dyshormogenetic goiter: Cytology.
Often hypercellular and pleomorphic.
A. Lining epithelium.
A. Respiratory or squamous.
B. Mucus glands and thyroid follicles.
Thyroglossal-duct cyst: Most commonly associated malignancy.
Papillary thyroid carcinoma.
Causes of finding of ciliated cells on FNA of the thyroid gland (2).
A. Anatomic site.
B. Origins (4).
A. Anterolateral neck.
B. 1st, 2nd, 3rd, or 4th branchial pouch.