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D&T test 6 - endocrine, dermatology, MSK > Path: Thyroid > Flashcards

Path: Thyroid Flashcards

1
Q

What are the 2 functional cells of the thyroid

A

follicular cells, parafollicular cells

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2
Q

What do the follicular cells do

A

convert thyroglobulin into T4 and T3

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3
Q

How does thyroid hormone exert it’s effects?

A

Multi-protein hormone receptor complex binds thyroid horomone respnse elements (TREs) in target genes –> upregulated transcription

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4
Q

Thyroid effects on CHON, CHO, and lipid

A

Increased CHO and lipid catabolism (breakdown)

Stimulates protein synthesis

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5
Q

Net effect of thyroid Homo

A

increased BMR (basal mtb rate)

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6
Q

4 B’s of thyroid homo

A

Brain Development
Bone growth
BMR increase
Beta-adrenergic effects

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7
Q

What do the parafollicular cells produce? name of cell?

A

calcitonin

C-cells

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8
Q

calcitonin 2 functions

A

bone absorption of Ca++

inhibits osteoclasts

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9
Q

what is T3/T4 levels in thyrotoxicosis

A

both elevated

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10
Q

What is MC cause of primary hyperthyroidism

A

MC = Diffuse gland hyperplasia related to Graves disease

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11
Q

2 non-graves causes of primary hyperthyroidism

A

Hyperfunctinoal multinodular goiter

Hyperfunctional adenoma

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12
Q

3 causes of secondary hyperthyroidism

A

Pituitary adenoma
Exogenous thyroid hormone intake
Inflammatory conditions

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13
Q

what is most useful screening test for hyperthyroidism

A

serum TSH

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14
Q

serum TSH levels in primary and secondary hyperthyroidism

A 
primary = low
secondary = high
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15
Q

RAI uptake in hyperthyroidism?

A

increased

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16
Q

diffuse or nodular hyperplasia in graves?

A

diffuse enlargenmnt

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17
Q

Cause of graves

A

AIDz: stimulating autoAbs vs TSH receptors

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18
Q

Ig type and HSR type in Graves

A

IgG, HSR type 2

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19
Q

What causes exopthalmos in Graves

A

T cells infiltrate behind eye–> cytokine release –> fibroblast secretion of GAGs –> edema, inflammation, increased adipocytes

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20
Q

histo findings of Graves (3)

A

crowded follicular cells, scalloped colloid (decreased colloid)

*lecture only- lymphoid follicles (aggregates of lymphoid tissues)

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21
Q

TSH, T3/T4, pattern of RAI uptake in Graves

A 
TSH = low
T3/4 = high
RAI = diffuse
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22
Q

2 cuases of Secondary hypothyroidism

A

piuitary problem, TSH deficiency

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23
Q

2 causes of Teritiary hypothyroidism:

A

problem of hypothalamus, TRH deficiency

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24
Q

Primary hypothryoidism- problem with what?

A

thyroid itself

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25
TSH levels in primary secondary and tertiary hypothyroidism
Primary: high | Secondary/tertiary: low
26
Cretinism/ Congenital hypothyroidism is usually dt?
Usually dt lack of iodine in childhood
27
Cretinism/ Congenital hypothyroidism can also be dt an inborn error of mtb (enzyme deficiency) - what enzyme and process?
thyroid peroxidase is deficient --> inability to synthesize thyroid hormone
28
What is myxedema (not pretibial)
Hypothyroididm in adult or older child
29
How does myxedema present
Progressive slowing of mental and physical activity: | Fatigue, cold intolerance, apathy
30
6 signs of myxedema
``` Periorbital edema, coarsening of features, cardiomegaly, fine hair/hair loss, deep voice, large tongue ```
31
define Thyroiditis
Inflammation of thyroid gland
32
MC cause of thyroiditis in iodine sufficient areas
Hashimotos thyroiditis
33
Hashimotos is mediated by what 5 cell types? and what HSR types
1. CD8+ = HSR type 4 2. 3. CD4 helpers --> INFy --> macrophages 4. 5. Antibody-dependent cell mediated toxicity (Anti-thyroid Abs- follicular cells destroyed by NK cells) (HSR II)
34
Describe Hurthle cells:
lymphoid aggregates in the thyroid with pink cytoplasm
35
Hashimotos is associated with increased risk of what cancer type
Lymphoma (NHL, B-cell)
36
What thyroid condtion is associated with Viral etiology with URTI
Subacute Granulomatous DeQuervain Thyroiditis
37
gross and histo of Subacute Granulomatous DeQuervain Thyroiditis
gross: enlarged, tender thyroid (only one = tender) histo: Multinucleated Giant cells surrounded by pools of colloid (granulomatous inflammation)
38
CP of Subacute Granulomatous DeQuervain Thyroiditis
Neck pain radiating to ear, jaw, etc with swallowing
39
thyroid function in Subacute Granulomatous DeQuervain Thyroiditis
hyper early, hypo late
40
define Reidel Thyroiditis
thyroid replaced by fibrous tissue with inflammatory cells
41
What does Reidel Thyroiditis mimic and how?
mimics anaplastic carcinoma through fibrosis extending to surrounding structures (penetrating capsule) --> obstructive symptoms
42
Reidel Thyroiditis (Fibrosing) presents as hypo or hyper?
hypo
43
What does a goiter signify
Reflects impaired synthesis of thyroid homo
44
Pathology of Endemic form of goiter
low iodine--> decreased T3/4--> increased TSH --> follicular cell hypertrophy/plasia
45
Pathology of Sporadic form of goiter
cruciferous veggies interfere with thyroid homo synth | or hereditary enzyme defects
46
in a Diffuse non-toxic goiter, what do problems arise from and notable not arise from
Problems arise from mass effects (no hormone dysregulation)
47
What causes a multinodular goiter
Repeated stimulation, involution episodes --> multilobulated, assymetrical glands
48
multinodular goiter: homo level RAI uptake problems arise from
homo= euthyroid RAI = uneven (duh - nodules) problems arise from mass effect
49
What is Plummer syndrome =
hyperfuncitoning nodule in the setting of multinodular goiter
50
Which is more likely neoplastic: solitary or multiple nodules
Solitary nodules more likely neoplastic
51
In what age are nodules more likely neoplastic
Nodules in younger patients (<40) more likely neoplastic
52
In what gender are nodules more likely neoplastic
males
53
Are"Hot” nodules (take up radioactive iodine) more likely neoplastic or benign.
benign
54
What is used to dx all thyroid nodules
Fine Needle Aspiration (FNA)
55
What distinguishes thyroid adenoma from carcinoma
Integrity of capsule
56
``` thyroid adenomas: derived from hot or cold nodules benign or neoplastic solitary or multiple ```
derived from follicular epi usually cold usually benign solitary ***it breaks all the rules!
57
histo chcs of thyroid adenoma (2)
``` Uniform, small follicles with colloid hurthle cells (pink fluffy) ```
58
4 types of CA of thyroid from most to least common
``` Papillary CA (MC) Follicular CA (10-20%) Medullary CA (5%) Anaplastic CA (<5%) ```
59
Age and gender of Papillary CA
20-50 | F > M
60
risk factor for papillary CA
prior ionizing radiation
61
mutation assc with papillary CA (2)
RET, BRAF (both protoncogenes)
62
Papillary CA behavior?
tends to invade LNs
63
how to Dx papillary CA
nuclear features: 1. "Orphan Annie eye" nuclei - empty nuclei devoid of nucleoli (clear) 2. Nuclear grooves 3. intranuclear inclusions 4. Psammoma bodies
64
px of papillary CA
excellent
65
Prognsosis of Follicular CA depends on?
mount of invasion at diagnosis
66
Follicular CA likes what type of mets
hematogenous spread
67
how to dx follicular CA?
invasion through capsule (vs thyroid adenoma)
68
10 year survival of follicular CA
50%
69
Medullary Carcinoma of Thyroid derived from what?
parafollicular C-cells
70
Medullary Carcinoma of Thyroid produces?
produces calcitonin
71
Medullary Carcinoma of Thyroid histo
sheets of cells in amyloid stroma (dense acellular material)
72
Medullary Carcinoma of Thyroid: mutations (2) familiar syndrome associations (3) which is most aggressive?
FTMC gene mutation = indolent mutation in RET: MEN2A = intermediate MEN2B = aggressive (mets)
73
Sporadic form of medullary CA present how? age
40-60 | mass effect: dysphagia, hoarseness, cough
74
What is mnemonic for medullary CA
"Larry, Amy, Toni" = meduLARRY AMYloid stroma secretes calciTONIn
75
Anaplastic CA px
terrible: mortality rate approaching 100%
76
Histo of Anaplastic CA
Looks totally undifferentiated
77
Anaplastic CA : age
older pop ~65
78
CP of anaplastic CA
rapidly enlarging Mass effect in neck
79
Tx of lymphoma
complete thyroidectomy
80
Lymphoma of thyroid is assc with?
Hashimotos thyroiditis

D&T test 6 - endocrine, dermatology, MSK (22 decks)

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