Flashcards in EXAM #1: PATHOLOGY OF THYROID Deck (48):
1
What are the signs and symptoms of hyperthyroidism?
1) Hypermetabolism
2) Enhanced epinephrine effect (tremulous and anxiety)
3) Lid lag
4) A-fib
5) Thyroid storm
2
What is "lid lag?"
A delay in the downward movement of the upper eyelid
3
A young female patient is sweaty with a-fib. What do you need to rule out?
Thyroid disease
4
What is thyroid storm?
- This is an acute, life-threatening, hypermetabolic state
- Induced by excessive release of thyroid hormones (THs) in individuals with thyrotoxicosis (Grave's Disease)
*Typically from surgery of childbirth*
5
What is Graves' Disease?
Autoimmune disease with production of IgG antibody vs. TSH receptor
6
What is the sex-predominance in Graves' Disease?
Female
7
What are the labs that are seen in Graves' Disease?
High T3/T4 with LOW TSH
8
What are the ophthalmologic consequences of Grave's Disease?
Proptosis/ Exopthalmous
9
What is myxedema?
Swelling of the skin and underlying tissues of the shin giving a waxy/doughy consistency
*This is due to TSH stimulation of fibroblasts with TSHR
10
What is myxedema most commonly associated with?
HYPOthyroid--however, sometimes it is seen in HYPER; be sure to associate with other symptoms
*Iodine deficiency leads to increased TSH release OR, TSH antibodies in graves
11
What is the gross appearance of the thyroid gland in Grave's Disease?
Diffuse, symmetrically beefy red gland
12
What is the histologic appearance of Grave's Disease?
- Pale colloid with resporption vacuoles i.e. "scalloping"
- Hyperplastic follicles with papillary infoldings
13
What are the signs and symptoms of Hypothyroid?
1) Slowing of mind and body
2) Myxedema (accumulation of hydrophilic ground substance in connective tissue)
14
What is the name of the disease that occurs when a child has hypothyroid?
Cretinism
15
What are the clinical features of cretinism?
1) Stunted growth
2) Retarded mental development
3) Delayed bone and tooth development (2-4 months is normal)
Also, facial swelling, puffy eyelids, protruding tongue, low hair line, and altered eyebrows.
16
When does thyroid hormone need to be replaced to reverse the course of cretinism?
Before the 3rd week
*Note that legally you are abound to screen for cretinism
17
What is Hashimoto Thyroiditis?
Chronic progressive thyroid disease
*Presents as hyperthyroid then progresses to hypothyroid
18
What causes Hashimoto Thyroiditis?
Autoimmune destruction of the thyroid gland associated with HLA-DR5
19
What is the gross appearance of Hashimoto Thyroiditis?
- Diffusely enlarged
- Pale
- Intact
20
What is the histologically pathognomonic for Hashimoto Thyroiditis?
Hurtle Cells and chronic inflammation with germinal centers
21
What is a Hurtle Cell?
Metaplasia of the cells that line the thyroid follicle due to autoimmune attack
22
What is De Quervain Thyroiditis?
Transient granulomatous hyperthyroidism secondary to viral infection
23
What causes De Quervain Thyroiditis?
Viral infection esp. by coxsackie and adenovirus
24
What is the sex predominance of De Quervain Thyroiditis?
Female
25
What is the unique clinical aspect of De Quervain Thyroiditis?
PAIN/TENDERNESS
26
What is a Goiter?
Thyroid enlargement, usually due to relative iodine deficiency
27
What causes Goiter?
Impaired ability of thyroid to produce thyroid hormone
28
What happens to TSH with goiter?
Elevated
29
What causes Goiter?
Typically:
- Decreased iodide
- Compensatory increase in TSH leads to enlargement
30
What is a Colloid Goiter?
Beginning smooth goiter
31
What does colloid goiter progress to?
Nodular goiter
32
How will goiter appear histologically?
Colloid rich follicles with FLATTENED epithelium
33
What is the difference between hot and cold nodules? Why is it important to known the difference?
Hot= palpable mass that accumulates increased radioiodine
Cold= palpable mass that fails to take-up radiolabeled iodine
- More associated with adenoma and carcinoma
34
What is the next step in diagnosing a cold nodule?
Fine Needle Aspiration (FNA)
35
What is a thyroid adenoma?
Benign thyroid tumor
*Remember--if a female has thyroid adenome and a new problem it is very unlikley the tumor has turned malignant
36
What is the sex predominance of thyroid adenomas?
Female
37
What is the most common type of thyroid cancer? What is the prognosis?
Papillary= good prognosis
38
What is the type of thyroid cancer with the worst prognosis?
Anaplastic
*Nearly all die of it in a short time (3-6 months)
39
What is a major risk factor for papillary thyroid cancer?
Ionizing radiation
*Clinically this is associated with children that get radiation to the face for severe acne
40
What is a papillary carcinoma composed of?
Papillae lined by cells with
- Orphan Annie eye nuclei
- Nuclear Grooves
*Also, papillae are associated with psammoma bodies
41
What is a follicular carcinoma?
Malignant proliferation of thyroid follicles surrounded by a fibrous capsule with INVASION through the capsule
42
What is medullary carcinoma?
Malignant proliferation of parafollicular C cells
43
What does biopsy of a medullary carcinoma reveal?
Sheets of malignant cells in an amyloid stroma
44
What genetic mutation is medullary carcinoma associated with?
RET oncogene
45
What disorders is medullary carcinoma associated with?
MEN 2A and 2B
46
If a patient has a RET mutation, what surgical procedure is warranted?
Prophylactic thyroidectomy
47
What is an anaplastic carcinoma?
Undifferentiated malignant tumor of the thyroid
48