Hypothyroidism

Question 1

what types of myxedema are seen in hypo and hyperthyroidism?

Answer 1

Hypo: myxedema (facial/periorbital)
Hyper: pretibial myxedema

Question 2

What are the drugs used to treat hypothyroidism?

Answer 2

levothyroxine (synthetic T4)

triiodothyronine (synthetic T3)

Question 3

Which antibodies are seen in Hashimoto thyroiditis?

Answer 3

anti-thyroid peroxidase
antimicroscomal
antithyroglobulin

Question 4

Those w/ Hashimoto have increased risk for what?

Answer 4

Non-hodgkin (b cell) lymphoma

Question 5

Which genetic associations are there w/ Hashimoto’s?

Answer 5

HLA-DR5

HLA-B5

Question 6

What is the genetic association for Grave’s?

Answer 6

HLA-DR3, HLA-B8

Question 7

What are the gross findings in Hashimoto’s?

Answer 7

painless goiter

hypothyroidism symptoms

Question 8

What is found on histo w/ Hashimoto’s?

Answer 8

Hurthle cells

lymphoid aggregate w/ germinal centers

Question 9

What are the stages of Hashimoto’s?

Answer 9

Euthyroid, see antibodies only
Inflammation: hyperthyroid
Destruction of thyroid: hypothyroid. Shrunken goiter. Histo looks like lymph nodes, lymphocytes etc.

Question 10

What are some meds that can cause hypothyroidism?

Answer 10

amiodarone
tyrosine kinase inhibitors (chemo)
lithium

Question 11

What are the 6Ps of congenital hypothyroidism/cretinism?

Answer 11

6Ps
Pot-bellied
Pale
Puffy-faced
Protruding umbilicus
Protuberant tongue
Poor brain development (ID)

Question 12

Describe the course of subacute thyroiditis/de Quervain?

Answer 12

triggered by viral URI
early on: hyperthyroidism
then: hypothyroidism

Question 13

What is the physical manifestation of subacute thyroiditis?

Answer 13

hypothyroidism symptoms

painFUL goiter

Question 14

What is the histo of subacute thyroidits?

Answer 14

granulomatous inflammation

Question 15

What is the genetic connection w/ subacute thyroiditis?

Answer 15

HLAB35

Question 16

Which types of viral URIs can trigger subacute thyroiditis?

Answer 16

coxsackie virus
echovirus
adenovirus
measles
mumps

Question 17

What is the treatment for subacute thyroidits?

Answer 17

NSAIDs and corticosteroids for pain

levothyroxine, once you have hypothyroidism

Question 18

What happens in Riedel thyroiditis?

Answer 18

thyroid tissue replaced by fibrous tissue
this fibrosis can extend into other tissues (invasive)

see fixed hard painLESS goiter

Question 19

What do you see on histo w/ Riedel thyroiditis?

Answer 19

macrophages eosinophils

Question 20

What is the histo of the most common thyroid cancer?

Answer 20

Papillary Carcinoma
orphan anne nuclei (cleared out)
psammoma bodies

Question 21

Which genetic mutations are associated w/ papillary carcinoma?

Answer 21

RET
BRAF
tyrosine kinase receptors

Question 22

Thyroidectomy followed by high dose radioactive iodine therapy is recommended for the treatment of which thyroid cancers?

Answer 22

papillary carcinoma
follicular carcinoma
NOT medullary carcinoma b/c this is a cancer of C cells!

Question 23

Aside from papillary carcinoma, which other thyroid cancer has a RET mutation & also has MEN2A&2B mutations?

Answer 23

Medullary carcinoma

Question 24

What’s the deal with follicular carcinoma?

Answer 24

same as follicular adenoma, except that it invades the capsule

thank goodness has different genetic markers than follicular adenoma b/c can’t tell capsule invasion w/ FNA. Now, fewer unnecessary surgeries

Question 25

Why is it important to check patients w/ medullary carcinoma for pheochromocytoma before taking them to surgery?

Answer 25

b/c they have MEN2A & 2B mutations. High likelihood of pheochromocytoma

remember–this is a cancer of the C cells of the thyroid, high calcitonin

Question 26

You see invasive thing originating from the thyroid. Young pt what do you suspect? old pt?

Answer 26

Young-Riedel thyroiditis

Old-Anaplastic Carcinoma, sad b/c poor prognosis