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Endocrine II AH > Thyroid - Guerin > Flashcards

Thyroid - Guerin Flashcards

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1
Q

Goiter is caused by what?

What thyroid state?

A

Impaired synthesis of thyroid hormone, most often result of dietary iodine deficiency

Euthyroid

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2
Q

What feature of follicular variant PTC makes it aggressive?

A

Poorly circumscribed and infiltrative

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3
Q

Hashimoto’s is associated with polymorphisms in what?

A

CTLA4 and PTPN22

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4
Q

Secondary (pituitary-associated) cause of hyperthyroidism may be excluded with what?

A

TRH stimulation test

Normal rise in TSH after admin TRH excludes secondary causes

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5
Q

Peak age of Graves?

Triad of CF?

A

20-40

Hyperthyroidism w/big gland, exophthalmos, dermopathy (pretibial myxedema)

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6
Q

What tumor marker is helpful in monitoring sporadic medullary carcinoma?

Diarrhea may be caused due to what?

A

CEA

VIP

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7
Q

What is apathetic hyperthyroidism?

Lab tests?

A

Thyrotoxicosis in older adults

Low TSH, high T4

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8
Q

What clues tell you a thyroid nodule is more likely neoplastic?

A

Male
Younger pt
Solitary nodule
Hx of radiation to H and N

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9
Q

What presents w/painless mild hyperthyroidism and goitrous enlargement in middle-aged pts?

Have what circulating?

Up to 1/3 evolve into what?

A

Subacute lymphocytic thyroiditis (occurs in 5% postpartum)

Antithyroid peroxidase Abs

Over hypothyroidism

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10
Q

What is a thyroglobulin duct cyst?

A

Vestige of the tubular thyroid leading to a persistent sinus tract

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11
Q

Granulomatous (De Quervain) thyroiditis affects who?

Triggered by what?

Common when?

A

W 40-50 y/o

Viral infection (uri)

Summer

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12
Q

Mean age of anaplastic carcinoma?

Prognosis?

A

65

Highly aggressive, 100% mortality

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13
Q

What temperature sensation is common with hyperthyroidism?

A

Heat intolerance (always feel hot)

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14
Q

Thyroglossal duct cysts high in the neck are lined by what?

Lower neck?

A

Stratified squamous epithelium

Epithelium resembling thyroidal acinar epithelium

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15
Q

Thyroid hormone affects bones how?

A

Stimulates bone resorption leading to osteoporosis and risk of fractures

Atrophy of skeletal m.

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16
Q

What typically presents as a solitary nodule, with amyloid deposits present in the stroma?

Tumor cells (+) for what?

A

Medullary carcinoma

Calcitonin

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17
Q

What cancer has small follicles with colloid w/uniform cells and the nuclei lack the features typical of papillary carcinoma?

What is most important in diagnosing?

A

Follicular carcinoma

Capsular invasion

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18
Q

What % of solitary thyroid nodules are malignant?

Clinical course of these cancers?

A

< 1%

Indolent

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19
Q

Treatment for hyperthyroidism?

A

Beta blocker
thionamide
Iodine
Radioiodine ablation

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20
Q

Hashimoto’s is due to what Pathogenesis?

What mechanisms of cell injury?

A

Breakdown in self tolerance

CD8 - CTL
CD4 - Macrophage
Plasma cell - NK cell (ADCC)

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21
Q

What gene mutation seen in medullary carcinoma?

A

RET

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22
Q

Thyroid parafollicular (C) cells make what?

A

Calcitonin (promotes absorption of calcium by the skeletal system)

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23
Q

What is the most common cause of thyroid pain?

CFs?

Lab values?

A

Granulomatous (De Quervian) thyroditis

Inflammation, hyperthyroidism that lasts 2-6 weeks

High T3, T4
Low TSH
Low radioactive iodine

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24
Q

Peak incidence of PTC?

A

25-50

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25
What genetic defects in thyroid development can cause hypothyroidism?
TSH, PAX8, FOXE1 Toilet Paper Fool
26
Is hypocalcemia seen in sporadic medullary carcinoma?
NO
27
What is an form of extensive fibrosis of the thyroid which mimics thyroid carcinoma? Related to what?
Riddle thyroiditis Autoimmune IgG4 sclerosing disease
28
Thyroid adenoma main morphology?
Well-defined capsule | Oxyphil or Hurthle cell change
29
Sporadic goiter occurs in whom? Peaks when? Caused by what?
Females at puberty or young adult Unknown
30
Diffusely increased radioactive iodine uptake seen in what? Increased uptake? Decreased uptake?
Graves Solitary nodule (toxic adenoma) Thyroiditis
31
What is described by an autonomous nodule developing into long-standing goiter and produces hyperthyroidism?
Plummer syndrome
32
What has the morphology of mononuclear inflammatory infiltrate w/well developed germinal centers, loss of thyroid follicles and fibrosis that does not extend beyond the capsule? Buzz word?
Hashimoto's Hurthle cell - epithelial cell w/eosinophilic cytoplasm
33
Clinical course of follicular carcinoma? What kind of spread? Prognosis depends on what?
Slowly growing painless nodule, "cold" nodule Vascular (hematogenous) Extent of invasion and stage
34
What type of thyroid carcinoma occurs in older individuals and portends a worse prognosis? What mutation are present?
Tall-cell variant PTC BRAF RET/PTC translocation
35
Diagnose PTC how? Treat? Prognosis?
Radionuclide scanning - cold nodules and FNA Total thyroidectomy, chemo, radiation Excellent but less favorable for pts > 40 y/o
36
What is myxedema? Basic CFs? How is cholesterol and LDL affected?
Hypothyroidism in older child or adult Fatigue, apathy, mental sluggishness, Dec CO Both increased
37
What causes multinodular goiter?
Recurrent episodes of hyperplasia and involution Occur in sporadic and endemic
38
Graves treatment?
Beta blocker Thionamide (PTU) Surgery/ablation
39
What has lymphocytic infiltration w/large GCs, patchy distribution and collapse of thyroid follicles but NO fibrosis and NO Hurthle cells?
Subacute lymphocytic thyroiditis
40
Describe the following labs in Graves: TSH T3, T4 Radioiodine
Low High Increased
41
what are goitrogens? Suppress what? What increases? Examples?
Chemical agents that inhibit thyroid gland functions T3 and T4 TSH PTU, iodine in large doses
42
What is the incidence of malignancy in long-standing multinodular goiters?
Low - 5%
43
90% of pts w/Graves have what? What polymorphisms may these pts have?
TSI (binds TSH receptor and mimics its action) CTLA4, PTPN22, HLA-DR3
44
Hasimoto's peak ages and sex? Autoantibodies to what?
Women 45-65 Anti-microsomes Antithyroid peroxidase Antithyroglobulin
45
Pts w/Hashimoto's have increased risk of developing what other autoimmune diseases? Increased risk of developing what else?
T1DM, adrenalitis, SLE, MG, Sjogren Extranodal Marginal zone B-cell lymphoma
46
What clues tell you a thyroid nodule is more likely benign?
Multiple nodules Older pt Female Hot nodule
47
The familial form of medullary carcinoma morphology described how?
Bilaterally w/multiple foci
48
What is the most sensitive screening test for hypothyroidism? Increased or decreased for primary hypothyroidism? What about T4?
Serum TSH level Increased T4 decreased
49
What has a nuclear groove, pseudo-inclusions and finely dispersed chromatin making them appear clear or empty? Buzz word?
Papillary carcinoma Ground-glass or Orphan Annie eye nuclei
50
Diffuse nontoxic (simple) goiter TSH level? T3, T4? Therefore they are mostly what?
Elevated Normal Euthyroid
51
What has uni or bilaterally enlarged and firm thyroid, multinucleate giant cells around colloid?
De Quervian (granulomatous))
52
What drugs can cause hypothyroidism?
Lithium Iodines P-aminosalicylic acid
53
What causes an uneven radioiodine uptake and sometimes a "hot" nodule from an admixture of hyperplastic and involuting nodules? What can be helpful in diagnosing it?
Multinodular goiter FNA
54
What is the thyrotoxicosis?
Hypermetabolic state caused by elevated circulating levels of free T3 and T4, most commonly due to hyperthyroidism
55
Where is endemic goiter common? Pathogenesis?
Low levels of iodine - Andes and Himalayas No iodine -> dec synthesis of thyroid hormone -> inc TSH -> follicular cell hypertrophy and hyperplasia -> goiter gets big
56
What presents as a unilateral painless mass discovered during routine physical, is nonfunctional in general, with uniform and bland cells?
Thyroid adenoma
57
CF of Hashimoto's? Lab findings in hasitoxicosis?
Painless enlargement of thyroid, symmetric and diffuse Free T3 and T4 INC TSH Dec Radioactive iodine Dec
58
How do you 1st diagnose a thyroid adenoma? Then what? Ultimately need to do what?
Radionuclide scan, cold nodules take up less radioactive iodine US and FNA Surgically resect to examine capsule
59
An isolated cervical nodal metastasis in PTC has what influence on prognosis?
NONE
60
Which medullary carcinomas are generally more aggressive? What action to take?
MEN-2B Prophylactic thyroidectomy
61
3 main CF of multinodular goiter?
Mass effects then Cosmetic Airway obstruction and dysphagia SVC syndrome
62
30% of medullary carcinomas are familial due to what?
MEN 2A or 2B | Familial medullary TC
63
What binds T3 and T4? How is T4 converted to T3?
TBG and transthyretin deiodinated in periphery
64
Prognosis of encapsulated follicular variant of PTC? Mutation in what? What kind of architecture does it have?
Favorable RAS Follicular
65
Medullary carcinomas are derived from what? Secrete what? What else may they secrete?
C cells Calcitonin Serotonin, ACTH, VIP
66
What condition may produce an audible bruit over the thyroid gland? Pts at risk for what else?
Graves SLE, Pernicious anemia, Addison's, DM DAPS
67
Treatment for follicular carcinoma?
Total thyroidectomy followed by radioactive iodine Thyroid hormone as well
68
Thyroid storm is what? Occurs in whom? Results from what? CFs?
Abrupt onset of severe hyperthyroidism Pts w/underlying Graves Acute elevation in catecholamines from any stress Febrile, tachycardia --> medical emergency due to cardiac arrhythmia
69
What structure in the eye expresses the TSH receptor?
Orbital preadipocyte fibroblasts
70
What is monitored after tx of follicular carcinoma?
Serum thyroglobulin
71
Thyroid hormone resistance syndrome caused by what? Leads to what?
THRB mutation Hypothyroidism
72
What is hypothyroidism in infancy or early childhood called? Found where? CFs?
Cretinism Dietary iodine deficiency endemic --> Himalaya, China, Africa Mental retardation, short stature, coarse facial features, protruding tongue, umbilical hernia (5 total)
73
Follicular carcinoma more common in whom? Peak incidence?
Women 40-60 y/o
74
What presents as a rapidly enlarging bulky neck mass w/symptoms related to compression of adjacent structures?
Anaplastic carcinoma
75
What are the types of thyroid carcinomas?
``` PFAM Papillary - 85% Follicular 5-15% Anaplastic Medullary from C cells and NOT follicular epithelium ```
76
How does hyperthyroidism affect the gut?
Hyperstimulates it causing diarrhea and malabsorption
77
What converts thyroglobulin to T3 and T4 (thyroxine)? Which is more potent?
Follicular cells T3
78
What is described by pale colloid w/scalloped margins, lacking fibrovascular cores, and diffuse hypertrophy and hyperplasia of thyroid follicular epithelial cells?
Graves
79
Who and when get thyroid carcinomas? What gives an increased risk?
Women in early and middle adult years Ionizing radiation early in life --> papillary carcinoma Iodine deficiency --> follicular carcinoma
80
What shows giant cells, spindle cells, mixed cells and is (+) for cytokeratin on morphologic exam?
Anaplastic carcinoma
81
What mutation in papillary carcinoma is an adverse prognostic factor?
BRAF

Endocrine II AH (6 decks)

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