Illness Scripts Flashcards
(6 cards)
55 year old woman presents with painless enlargement of the thyroid, mental slugishness, decreased GI motility and constipation.
She describes over the past few weeks her symptoms have changed from flushed skin and sweating with increased appetite and weight loss with guy hypermotility to her current symptoms.
Inc. TSH and Low T3/T4
What is the disease?
Hashimoto Thyroiditis. Autoimmune destruction of the thyroid gland.
Progressive depeletion of the thyroid elithelial cells (Thyrocytes) and their replacement by mononuclear cells infiltrates and fibrosis.
What is the damage to they thyrocytes mediated by in Hashimoto Thyroiditis ?
T cell mediated Cyto-toxicity
Thyrocyte injury via cytokines released from Th1 (INF-Gamma)
Antibody dependent Cell mediated cytotoxicity—> NK cells recognize antibody (Released from plasma cells) with their Fc receptors and release granzymes.
Patient shifts from thyrotoxicosis to hypothyroidism.
Describe this histology
What cell is unique to this disease ?
Hashimoto thyroiditis —> the thyroid parenchyma contains a dense lymphocytic infiltrate with germinal centers.
Residual thyroid follicles are lined by DEEPLY EOSINOPHILLIC HURTHLE CELLS which contain cytoplasmic inclusion bodies.
Pain in the neck, Fever, Maliase, variable enlargement of the thyroid. Thyrotoxicosis. Increased Leukocyte count and erythrocyte sedimentation rate.
Describe the pahtogenesis of this disese.
DeQuervine thyroiditis —> Viral Thyroiditis.
Characterized by disruption of thyroid follicles with extravasation of colloid leading to polymononuclear cell infiltrate. This will be replaced over time with lymphocytes, plasma cells, and mononuclear cells.
Disease is self limiting because it is not autoimmune.
Women presents with painless enlargement of her thyroid following pregnancy. She had symptoms of thyroxicosis but now has shifted to a euthyroid presentation.
What is the pathogenesis of this disease?
Subacute Lymphocytic Thyroiditis.
Patient will eventually progress to hypothyroidism. This is an autoimmune mediated disease
Thyroxicosis–> Euthyroid –> Hypothyroid
Lymphocytic infiltration and hyperplastic germinal centers within the thyroid paranchyma
The thyroid is fibrosed and you see antithyroid Ab in circulation ?
Riedel Thyroiditis —> characterized by extensive fibrosis of the thyroid and surrounding neck structures.
