Thyroid Path Flashcards

1
Q

elderly adult with unexplained weight loss and cardiovascular disease may have

A

apathetic hyperthyroidism

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2
Q

name the components of the burch-wartofsky score

A
  1. fever
  2. cardiac (tachy, CHF)
  3. GI (jaundice, diarrhea)
  4. precipitating history (pregnancy/postpartum, hemithyroidectomy, amiodarone)
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3
Q

describe the treatment of thyroid strom

A
  1. PTU
  2. B-blockers
  3. steroids
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4
Q

why is PTU used in the treatment of thyroid storm?

A

inhibits:

  1. peroxidase
  2. peripheral conversion of T4 —> T3
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5
Q

pt presents with arrhythmia, fever, vomiting and hypovolemic shock, consider…

A

thyroid storm

“tachycardia will be out of proportion to fever”

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6
Q
  1. hyperthyroidism with gland enlargement
  2. infiltrative opthalmopathy
  3. pretibial myxedema
A

grave’s disease

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7
Q

scalloping

A

grave’s disease

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8
Q

T3/T4: high
TSH: low
TSI: high

A

grave’s disease

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9
Q

describe the pathogenesis of pretibial myxedema and exophthalmos in graves disease

A

fibroblasts express TSH receptor

activation –> glycosaminoglycan (chondroitin sulfate and hyaluronic acid) buildup, inflammation, fibrosis, and edema

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10
Q

what type of hypersensitivity reaction is grave’s disease?

A

TIIHSN

IgG autoAb stimulate TSH receptor; MC AB is TSI

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11
Q

what changes are responsible for the increase in BMR in hyperthyroidism?

A

increased synthesis Na-K ATPase

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12
Q

what changes are responsible for the increase in sympathetic activity in hyperthryroidism?

A

increased expression B1-adrenergic receptor

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13
Q

describe the presentation of cretinism

A
  • growth and mental retardation
  • coarse facial features
  • umbilical hernia
  • enlarged tongue
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14
Q

one cause of cretinism is dyshormonogenetic goiter, which is due to…

A

congenital defect in thyroid hormone production – most commonly involving thyroid peroxidase

other causes: thyroid agenesis, maternal hypothyroidism

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15
Q

thyroglossal duct cyst presents as

A

anterior neck mass

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16
Q

lingual thyroid presents as

A

base of tongue mass

this is persistence of thyroid tissue at the base of the tongue

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17
Q

multinodular goiter is due to

A

iodine deficiency

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18
Q

how is cassava root a goitrogen?

A

a thiocyanate; inhibits iodide transport in thyroid

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19
Q

how does a toxic goiter develop?

A

regions of a multinodular goiter become TSH-independent —> release T4 —> hyperthyroidism

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20
Q

what age group is affected by myxedema?

A

older children and adults

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21
Q

is hyperglycemia seen in hyper or hypothyroidism?

explain why

A

hyperthyroidism

TH causes gluconeogenesis and glycogenolysis effects

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22
Q

is hypercholesterolemia seen in hyper or hypothyroidism?

A

hypothyroidism

note: cardiac output is decreased, bradycardia

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23
Q

in hypothyroidism, this results in a deepening of the voice and large tongue

A

myxedema

pts also have cold intolerance, weight gain, and mental and physical slowing

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24
Q

what are the most common causes of myxedema?

A

iodine deficiency and Hashimoto thyroiditis

also: lithium; surgical removal or ablation of thyroid

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25
Hashimoto thyroiditis is associated with HLA...
DR5
26
initially Hashimoto may present as hyperthyroidism, why?
follicle damage -- release of hormones aka Hashitoxicosis
27
Hashimoto will progress to presenting with...
hypothyroidism; low T4 & elevated TSH
28
Hashimoto has autoAbs against...
thyroglobulin (Tg) & thyroid peroxidase (TPO) possibly: anti-microsomal
29
histology: chronic inflammation (lymphocytic infiltrate) with germinal centers & Hurthle cells (eosinophilic metaplasia of cells lining the follicles)
Hashimoto thyroiditis
30
Hashimoto thyroiditis results in increased risk for
B-cell (marginal zone) lymphoma
31
enlarging thyroid gland late in Hashimoto thyroiditis disease course is concerning for
B-cell (marginal zone) lymphoma
32
name the four euthyroid diseases
1. granulomatous (+) 2. subacute (-) 3. Riedel* 4. neoplasms *really, only hypothyroid (-)
33
transient period of thyroid hormone irregularities (usually hypo), +/- goiter, painless
subacute lymphocytic thyroiditis ex: postpartum thyroiditis
34
this thyroiditis is painful, tender; possibly viral in origin (usually hyper)
subacute granulomatous (de Quervian) thyroiditis
35
subacute granulomatous (de Q) thyroiditis is associated with HLA...
B35
36
a young patient with a hard as wood and nontender thyroid...
riedel fibrosing thyroiditis
37
riedel fibrosis may extend to involve
local structures, such as the airway
38
how can you differentiate between riedel fibrosing thyroiditis and anaplastic carcinoma?
patient's with riedel are younger (40s)
39
a thyroid that is very pale after excision likely had what disease process?
riedel fibrosing thyroiditis
40
which thyroiditis is considered an IgG-4 related disease?
riedel fibrosing thyroiditis will show fibrosis (duh), lymphocytes, and *plasma cells*
41
what cells secrete IL-10 and TGF-B to induce IgG4 production and fibrosis?
Treg IL-10 ---> B cells & plasma cells TGF-B ---> fibroblasts
42
what are the three more common IgG-4 related diseases?
1. autoimmune pancreatitis 2. sclerosing mediastinitis 3. idiopathic retroperitoneal fibrosis
43
name the mass effect symptoms of a goiter
1. dysphagia 2. hoarseness 3. stridor 4. SVC syndrome
44
thyroid scintigraphy isn't great for determining malignancy but between hot and cold, which is more likely to be malignant?
cold
45
on uptake, graves disease and nodular goiter are usually
hot
46
on uptake, adenoma and carcinoma are usually
cold
47
benign proliferation of follicles surrounded by a fibrous capsule
follicular adenoma
48
what age group is papillary thyroid carcinoma seen in?
25-50
49
what is the most common type of thyroid carcinoma?
papillary carcinoma (80%) good prognosis (10 yr survival >95%)
50
what is a major risk factor for papillary thyroid carcinoma?
exposure to radiation in childhood (chernobyl)
51
histology: papillae lined by cells with clear "orphan annie eye" nuclei and nuclear grooves; psammoma bodies
papillary thyroid carcinoma
52
where does papillary thyroid carcinoma spread?
cervical LNs
53
how does papillary thyroid carcinoma present?
it is usually asymptomatic; palpable nodule or ultrasound possible
54
age is a significant factor in the staging of
thyroid carcinoma
55
RET-PTC & BRAF mutations
papillary thyroid carcinoma
56
what papillary thyroid carcinoma variant has RAS mutations?
follicular variant *RAS mutations are not specific though
57
what papillary thyroid carcinoma variant is seen in elderly patients? it is aggressive
tall cell variant
58
what papillary thyroid carcinoma variant is seen in kids and young adults? where does it mets?
diffuse sclerosing variant lung, brain, bone and liver - this variant has the tendency to recur and is aggressive, but has a good prognosis
59
RAS and PTEN mutations are seen in the follicular carcinoma, however this is not specific. which mutation is specific?
PAX8/PPARG fusion gene recall RAS is also seen in follicular variant of papillary thyroid carcinoma
60
what two types of invasion are seen in follicular carcinoma?
mushroom invasion (of the capsule) & angioinvasion
61
how does follicular carcinoma of the thyroid mets?
hematogenously (b/c of angioinvasion)
62
a rapidly enlarging, bulky neck mass in a pt 65+ with dysphagia and respiratory compromise is concerning for
anaplastic carcinoma of the thyroid
63
histology: orphan annie eye nuclei speckled necrosis large cells
anaplastic carcinoma an undifferentiated malignant tumor
64
constitutive tyrosine kinase activity in papillary carcinoma is due to what mutation?
RET/PTC
65
MAP kinase signaling in papillary carcinoma is due to what mutation?
BRAF
66
what thyroid carcinoma has TP53 mutations?
anaplastic
67
histology: cells are larger and have more cytoplasm what is their secretory product?
parafollicular c cells of the parathyroid gland -- they secrete calcitonin
68
histology: blue cells with dispersed chromatin; salt and pepper amyloid sheets of neuroendocrine cells c-cell hyperplasia
medullary carcinoma
69
calcitonin lowers serum calcium by...
increasing renal excretion of calcium
70
familial or sporadic medullary carcinoma? 50; unifocal, aggressive
sporadic 70-80% of medullary thyroid carcinomas
71
familial or sporadic medullary carcinoma? 43; multifocal, best prognosis
familial
72
familial cases of MTC are often due to...
MEN 2A and 2B
73
what mutation warrants prophylactic thyroidectomy?
RET -- familial MTC/MEN
74
describe how a pt with MTC could present with hypocalcemia
tumor produces high levels of calcitonin *monitor calcitonin for progress of the tumor
75
parathyroid hyperplasia, pheochromocytoma; MTC normal body habitus
MEN 2A "2 Ps)
76
pheochromocytoma, oral and intestinal ganglioneromatosis; MTC marfanoid body habitus
MEN 2B "1 P"