Thyroid part II

Question 1

What are first signs subacute lymphocytic thyroiditis

Answer 1

mild hyperthyroidis,, goitrous enlargement of gland

Question 2

demographics subacute lymphocytic thyroiditis

Answer 2

middle aged adults more common in women

Question 3

postpartum thyroiditis and subacute lymphcytic (painless) thyroiditis are subtypes of what

Answer 3

autoimmune thyroiditis

Question 4

must look into what with patient with painless thyroiditis

Answer 4

family history for autoimmune disorders

and look for antithyroid peroxidase Ab

Question 5

what is difference morpho of hashimoto and painless thyroditis

Answer 5

no fibrosis or hurthle cell metaplasia in painless thyroiditis

Question 6

progression of painless thyroiditis over 10 years

Answer 6

progress to hypothyroidism

Question 7

what cna trigger granulomatous thyroiditis

Answer 7

viral infeciton, usually URI

coxsackie, mumps, measles, adenoa and other viral infections

Question 8

describe radioactive iodine uptake in granulomaotus thyroidits

Answer 8

iodine uptake is diminished even though high T3 T4 and low TSH

Question 9

extensive fibrosis of thyroid and contiguous neck structures

Answer 9

riedel thyroiditis

Question 10

riedel thyroiditis is assoc with what

Answer 10

systemic autoimmune IgG4 disease

Question 11

start at

Answer 11

thyroid neoplasm

Question 12

what is the most common cause of impaired synthesis of thyroid hormone

Answer 12

dietary iodine deficiency

Question 13

what occurs with impaired synthesis of thyroid hormone

Answer 13

goiter, enlargement of thyroid

Question 14

what is a diffuse nontoxic goiter

Answer 14

enlargement without producing nodularity

Question 15

where are areas of endemic goiters

Answer 15

in the mountains, low levels iodine

Question 16

what food interfere with thyroid hormone synthesis

Answer 16

cabbage, cauliflower, brussel sprouts, turnips and cassava

Question 17

sporadic goiters are more common in who

Answer 17

young females at puberty or young adult life

Question 18

how does impairment of thyroid hormone synthesis lead to large thyroid

Answer 18

compensatory rise in TSH which causes hypertrophy and hyperplasia

Question 19

what are the phases of diffuse nontoxic goiter

Answer 19

hyperplastic phase and phase of colloid involution

Question 20

histo characteristics of colloid goiter

Answer 20

thyroid is brown and translucent, follicular epithelium is flattened cuboidal and colloid abundant

Question 21

clincal Sx nontoxic/simple goiter

Answer 21

mass effects from enlarged gland

Question 22

T3T4TSH levels in simple goiter

Answer 22

T3 T4 normal

TSH high normal

Question 23

recurrent episodes of hyperplasia of the thyroid can lead to what

Answer 23

multinodular goiter

Question 24

what is an intrathoracic or plunging goiter

Answer 24

when the thyroid grows behind the sternum

Question 25

microscopic appearance of colloid rich follicles with inactive epithelium and areas of follicular hyperplasia

Answer 25

multinodular goiter

Question 26

how to distinguish multinodular goiter from follicular neoplasm

Answer 26

absence of prominent capsule that is present in follicular neoplasm

Question 27

what can a large multinodular goiter lead to

Answer 27

airway obstruction, dysphagia and compression of large vessels in neck and upper thorax (superior vena cava syndrome)

Question 28

What is Plummer syndrome

Answer 28

toxic multinodular goiter when it starts to produce hyperthyroidism

Question 29

radioiodine scan of a toxic multinodular goiter

Answer 29

uneven iodine uptake

Question 30

what is a solitary thyroid nodule

Answer 30

palpable discrete swelling within an otherwise apparently normal gland

Question 31

what is the concern for a person with a thyroid nodule

Answer 31

possibility of malignant neoplasm | majority benign10:1

Question 32

what thyroid nodules are more likely to be neoplastic

Answer 32

solitary, nodules in younger patients nodules in males history of radiation

Question 33

hot nodules (take up lots of iodine) are more likely to be benign or malignant?

Answer 33

benign

Question 34

US can tell you what about thyroid mass

Answer 34

solid or cystic

Question 35

most thyroid adenomas are what

Answer 35

follicular adenomas because derived from follicular epithelium

Question 36

what is a toxic adenoma

Answer 36

an adenoma that produces thyroid hormones--> thyrotoxicosis | hormone production without stimulation

Question 37

morphology follicular adenoma

Answer 37

solitary, encapsulated lesion demarcated by intact capsule average 3 cm diameter gray-white to red brown areas of hemorrhage, fibrosis calcification and cystic changes

Question 38

difference of follicular adenoma from carcinoma

Answer 38

carcinoma invades BM

Question 39

Hurthle cell change

Answer 39

adenoma | lots of mitochondria, Tx aggressively

Question 40

nonfunctioning adenomas appear how on radionucleotide scan

Answer 40

cold nodules

Question 41

how is Dx made of thyroid adenoma

Answer 41

histologic examination of capsular integrity

Question 42

Common types of thyroid carcinomas

Answer 42

papillary-- majority!! follicular anaplastic (undifferentiated) medullary

Question 43

majority papillary carcinomas have what mutation

Answer 43

point mutation in BRAF signaling | some have RET translocation or inversion

Question 44

follicular and anaplastic carcinomas have what mutations

Answer 44

RAS point mutation PI3K point or amplification mutation PTEN point mutations

Question 45

majoirty of thyroid carcinomas are what

Answer 45

papillary

Question 46

gray/white tumor

Answer 46

papillary carcinoma till proven otherwise

Question 47

orphan annie nuclei (optically clear nuclei)

Answer 47

papillary carcinoma

Question 48

psamomma bodies

Answer 48

papillary carcinoma ovarian cancer craniopharyngioma

Question 49

patient with mass in cervical lymph node, otherwise asymptomatic

Answer 49

papillary carcinoma, isolated cervical mets no significance on prognosis

Question 50

good test for distinguishing benign and malignant papillary carcinomas

Answer 50

fine needle aspiration

Question 51

prognosis of papillary thyroid cancer

Answer 51

excellent | depends on age and distant mets