Pathology of the Thyroid I Flashcards Preview

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Flashcards in Pathology of the Thyroid I Deck (67):
1

thyroid axis

hypothalamus - TRH
anterior pituitary - TSH
thyroid - T3 and T4

T3 and T4 negative feedback on hypothalamus and anterior pituitary

TSH receptor - GPCR

2

42yo F sweating, pounding heart, weight loss, enlarged nontender thyroid, wide eye gaze

hyperthyroidism

3

eye protrusion in graves

accumulation of loose CT behind eyeballs

4

thyroid function testing

serum TSH and T4
ultrasound/radionucleotide uptake studies
serum Abs

5

low TSH and high T4

hyperthyroid

6

high TSH and low T4

hypothyroid

7

normal thyroid

euthyroid

8

ultrasound of thyroid

tells you cystic vs. solid

9

toxic

hyperfunctioning

10

elevated T3 and T4

thyrotoxicosis
-hypermetabolic state

11

majority of hyperthyroid

graves disease

diffuse hyperplasia of thyroid

also caused by multinodular goiter and thyroid adenoma

12

3 most common causes of thyrotoxicosis

graves disease**
multinodular goiter
thyroid adenoma

13

T4 vs. T3

T3 higher activity

T4 higher levels (10:1)

14

overactive sympathetics

with hyperthyroidism

15

increased metabolism, heat intolerance, weight loss with increased appeitite, tachycardia, palpitations, cardiomegaly, anxiety, insomnia

hyperthyroidism

16

early manifestations of hyperthyroidism

cardiac manifestations

tachy, palps, cardiomegaly

also atrial fib possible

complication - CHF

17

low output heart failure

thyrotoxic cardiomyopathy

reversible left ventricular dysfunction

individuals with hyperthyroidism

18

GI and hyperthyroid

hypermotility, diarrhea, malabsorption

19

lid lag

seen with hyperthyroid

-due to sympathetic overstiulation of mullers muscle (superior tarsal m)

20

proptosis

graves disease

protrusion of eyeballs

21

skeletal system and hyperthyroid

thyroid hormone - stimulates osteoporosis and increased fracture risk

22

sudden onset of severe hyperthyroid

thyroid storm

patient with graves disease and sudden increase in stress on body (infection, surgery,, etc.)

febrile and tachycardia

complication - untreated patient can die due to cardiac arrhythmias

23

women with hypothyroid

don't overtreat - can lead to osteoporosis

24

teratoma

commonly has thyroid tissue as well**

25

exopthalmos

graves disease

26

rash on front of shins

pretibial myxedema
-seen in graves disease

27

most common cause of endogenous hyperthyroid

graves disease

28

graves disease

females age 20-40yo

autoantibodies for TSH receptor - TSI

29

TSI

thyroid stimulating immunoglobulin

antibody present in graves disease** 90% of patients

30

symmetrical enlargement of thyroid

graves disease

diffuse hypertrophy and hyperplasia

diffuse enlargement of thyroid**

31

diffuse enlargement of thyroid

graves disease
-also increased blood supply
-may hear bruit

32

beefy red thyroid, heat intolerance, palpitations, enlarged thyroid, bruit

graves disease

33

exopthalmos with graves

inflammatory process causes this - glycosaminoglycan and lymphoid infiltrate deposition**

tx will move eyeballs back

if bad - corneal abrasions bc can't close eyelids

34

sympathetic overactivity

wide, staring gaze and lid lag

35

pretibial myxedema

seen in graves disease

basis of this localization is not clear

only in minority of patients

36

diagnosis of graves disease

elevated T4 and T3
depressed TSH levels

radioiodine scan - diffuse increased uptake of iodine

37

prognosis of graves disease

tx - beta-blockers for sympathetic sx

also to decrease thyroid hormone synthesis - thionamides, radioiodine ablation, thyroidectomy

38

surgery in graves

if large goiter compressing surrounding structure

39

42yo F weight gain, constipation, feels cold, thyroid symmetric and diffusely enlarged, TSH increased, T4 decreased

hypothyroid

decreased uptake on radionucleotide study

40

anti-TPO antibodies

hypothyroid
-hashimotos

41

common cause of hypothyroid

hashimotos

autoimmune destruction of thyroid

anti-TPO Abs

42

weight loss

graves

43

weight gain

hashimotos

44

graves vs. hashimotos

chronic inflammation in hashimotos

overstimulation in graves

45

pregnant women

hard to diagnose thyroid function

46

congenital hypothyroidism

worldwide

endemic iodine deficiency

47

autoimmune hypothyroidism

most common in iodine sufficient areas of world

48

live in mountains

goiter belt - central or south america

eat green veggies, live in himalayas, diffuse enlargement of neck

hypothyroid**

49

hypothyroid in childhood

cretinism

50

severe mental retardation, short stature, coarse facial features, protruding tongue, umbilical hernia

hypothyroid

maternal T3 and T4 cross placenta - critical for fetal brain development

51

myxedema

hypothyroidism in older child or adult

slowing of physical and mental activity

listless, cold intolerant, overweight

constipation, decreased sweating (decreased sympathetics)

52

atherogenic profile

with hypothyroidism

increased in total cholesterol and LDL levels

increased cardiovascular problems

53

nonpitting edema, broad coarse facial features, enlarged tongue, deep voice

hypothyroid

54

thyroiditis

inflammation of thyroid gland

55

fibrous thyroiditis

reidel

56

subtypes of thyroiditis

hashimoto - most common
granuloma (de quervain)
subacute lymphocytic thyroiditis

57

needle aspiration of thyroid with lots of lymphocytes

hashimotos
-inflammatory process

58

hurthle cells

in hashimoto thyroiditis

thyroid follicle atrophy lined with epithelial cells with abundant eosinophilic granular cytoplasm

59

painless enlargement of thyroid, symmetric and diffuse enlargement

hashimotos

60

transient thyrotoxicosis

hypothyroid preceded by transient thyrotoxicosis

in hashimotos - hashitoxicosis

during this phase - T3 and T3 elevated, TSH depressed, radioactive iodine uptake decreased

then later - T4 and T3 levels fall

61

increased risk of developing other autoimmune disease

hashimotos

both endocrine and nonendocrine

62

increased risk for development of marginal zone B cell lymphomas in thyroid

with hashimotos disease

63

subacute lymphocytic thyroiditis

middle aged women - often occurs after pregnancy
-postpartum thyroiditis

painless thyroiditis

antithyroid peroxidase (TPO) antibodies**

1/3 individuals to overt hypothyroid over 10 year period

64

granulomatous thyroiditis

de quervains

women age 40-50yo

triggered by viral infection
-history of upper respiratory infection

multinucleated giant cells

65

upper respiratory infection followed by thyroiditis

granulomatous thyroiditis

66

painful thyroid

granulomatous thyroiditis

67

fibrosis involving thyroid

reidel thyroiditis

rare disorder

associated with fibrosis of retroperitoneum
-manifestation of IgG4 autoimmune disease