EXAM #1: PATHOLOGY OF THYROID

Question 1

What are the signs and symptoms of hyperthyroidism?

Answer 1

1) Hypermetabolism
2) Enhanced epinephrine effect (tremulous and anxiety)
3) Lid lag
4) A-fib
5) Thyroid storm

Question 2

What is “lid lag?”

Answer 2

A delay in the downward movement of the upper eyelid

Question 3

A young female patient is sweaty with a-fib. What do you need to rule out?

Answer 3

Thyroid disease

Question 4

What is thyroid storm?

Answer 4

• 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

Question 5

What is Graves’ Disease?

Answer 5

Autoimmune disease with production of IgG antibody vs. TSH receptor

Question 6

What is the sex-predominance in Graves’ Disease?

Answer 6

Female

Question 7

What are the labs that are seen in Graves’ Disease?

Answer 7

High T3/T4 with LOW TSH

Question 8

What are the ophthalmologic consequences of Grave’s Disease?

Answer 8

Proptosis/ Exopthalmous

Question 9

What is myxedema?

Answer 9

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

Question 10

What is myxedema most commonly associated with?

Answer 10

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

Question 11

What is the gross appearance of the thyroid gland in Grave’s Disease?

Answer 11

Diffuse, symmetrically beefy red gland

Question 12

What is the histologic appearance of Grave’s Disease?

Answer 12

• Pale colloid with resporption vacuoles i.e. “scalloping”

- Hyperplastic follicles with papillary infoldings

Question 13

What are the signs and symptoms of Hypothyroid?

Answer 13

1) Slowing of mind and body

2) Myxedema (accumulation of hydrophilic ground substance in connective tissue)

Question 14

What is the name of the disease that occurs when a child has hypothyroid?

Answer 14

Cretinism

Question 15

What are the clinical features of cretinism?

Answer 15

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.

Question 16

When does thyroid hormone need to be replaced to reverse the course of cretinism?

Answer 16

Before the 3rd week

*Note that legally you are abound to screen for cretinism

Question 17

What is Hashimoto Thyroiditis?

Answer 17

Chronic progressive thyroid disease

*Presents as hyperthyroid then progresses to hypothyroid

Question 18

What causes Hashimoto Thyroiditis?

Answer 18

Autoimmune destruction of the thyroid gland associated with HLA-DR5

Question 19

What is the gross appearance of Hashimoto Thyroiditis?

Answer 19

• Diffusely enlarged
• Pale
• Intact

Question 20

What is the histologically pathognomonic for Hashimoto Thyroiditis?

Answer 20

Hurtle Cells and chronic inflammation with germinal centers

Question 21

What is a Hurtle Cell?

Answer 21

Metaplasia of the cells that line the thyroid follicle due to autoimmune attack

Question 22

What is De Quervain Thyroiditis?

Answer 22

Transient granulomatous hyperthyroidism secondary to viral infection

Question 23

What causes De Quervain Thyroiditis?

Answer 23

Viral infection esp. by coxsackie and adenovirus

Question 24

What is the sex predominance of De Quervain Thyroiditis?

Answer 24

Female

Question 25

What is the unique clinical aspect of De Quervain Thyroiditis?

Answer 25

PAIN/TENDERNESS

Question 26

What is a Goiter?

Answer 26

Thyroid enlargement, usually due to relative iodine deficiency

Question 27

What causes Goiter?

Answer 27

Impaired ability of thyroid to produce thyroid hormone

Question 28

What happens to TSH with goiter?

Answer 28

Elevated

Question 29

What causes Goiter?

Answer 29

Typically: - Decreased iodide - Compensatory increase in TSH leads to enlargement

Question 30

What is a Colloid Goiter?

Answer 30

Beginning smooth goiter

Question 31

What does colloid goiter progress to?

Answer 31

Nodular goiter

Question 32

How will goiter appear histologically?

Answer 32

Colloid rich follicles with FLATTENED epithelium

Question 33

What is the difference between hot and cold nodules? Why is it important to known the difference?

Answer 33

Hot= palpable mass that accumulates increased radioiodine Cold= palpable mass that fails to take-up radiolabeled iodine - More associated with adenoma and carcinoma

Question 34

What is the next step in diagnosing a cold nodule?

Answer 34

Fine Needle Aspiration (FNA)

Question 35

What is a thyroid adenoma?

Answer 35

Benign thyroid tumor *Remember--if a female has thyroid adenome and a new problem it is very unlikley the tumor has turned malignant

Question 36

What is the sex predominance of thyroid adenomas?

Answer 36

Female

Question 37

What is the most common type of thyroid cancer? What is the prognosis?

Answer 37

Papillary= good prognosis

Question 38

What is the type of thyroid cancer with the worst prognosis?

Answer 38

Anaplastic *Nearly all die of it in a short time (3-6 months)

Question 39

What is a major risk factor for papillary thyroid cancer?

Answer 39

Ionizing radiation *Clinically this is associated with children that get radiation to the face for severe acne

Question 40

What is a papillary carcinoma composed of?

Answer 40

Papillae lined by cells with - Orphan Annie eye nuclei - Nuclear Grooves *Also, papillae are associated with psammoma bodies

Question 41

What is a follicular carcinoma?

Answer 41

Malignant proliferation of thyroid follicles surrounded by a fibrous capsule with INVASION through the capsule

Question 42

What is medullary carcinoma?

Answer 42

Malignant proliferation of parafollicular C cells

Question 43

What does biopsy of a medullary carcinoma reveal?

Answer 43

Sheets of malignant cells in an amyloid stroma

Question 44

What genetic mutation is medullary carcinoma associated with?

Answer 44

RET oncogene

Question 45

What disorders is medullary carcinoma associated with?

Answer 45

MEN 2A and 2B

Question 46

If a patient has a RET mutation, what surgical procedure is warranted?

Answer 46

Prophylactic thyroidectomy

Question 47

What is an anaplastic carcinoma?

Answer 47

Undifferentiated malignant tumor of the thyroid

Question 48

What patient population is anaplastic carcinoma typically seen in? What condition is this is stark contrast to?

Answer 48

Elderly vs. Riedel Fibrosing Thyroiditis* that is seen in younger patients *This is chronic inflammation with extensive fibrosis of the thyroid gland--presents as hypothyroid with non-tender, "hard as wood" thyroid