Thyroid Path- Krafts Flashcards
Low TSH
Low T4
Secondary Hypothyroidism
High TSH
Low T4
Primary Hypothyroidism
Low TSH
High T4
Primary Hyperthyroidism
High TST
High T4
Secondary (or tertiary) hyperthyroidism
A little variation in T4 can cause a ______ fluctuation in TSH
LARGE
What are the 3 anti-thyroid antibodies you should check for?
Anti-peroxidase (anti-microsomal)
Anti-thyrogolobulin
Anti-TSH-receptor
What are you looking for when doing the radioiodine thryoid scanning?
Looking at iodine uptake
A lot of uptake = hot
Less active = cold (10% malignant)
Arrhythmias Tremor Lid Lag & wide staring gaze Warm, moist, flushed skin Diarrhea
Suggests……
HYPERthyroidism
Delayed reflexes Myxedema Slow pulse Constipation Dry, pale skin
Suggests….
HYPOthyroidism
What is cretinism?
Congenital Hypothyroidism
Which auto-antibody is most specific for Hashimotos?
Anti-peroxidase
Why is there transient hyperthyroidism in Hashimotos?
As follicles are destroyed some colloid leaks out
45 year old female:
Non-painful enlarged thyroid
Weight gain
Hyporeflexive
Lab Tests:
+ anti-peroxidase
+anti-TSH-receptor
FNA:
Hurthle Cells
Many germinal centers
Hashimotos
What thyroiditis is associated with a recent viral upper respiratory infection?
DeQuervain Thyroiditis (aka subacute or granulomatous)
30 year old male
Flu-like syptoms
Throat pain radiating to ear
Enlarged thyroid
DeQuervain Thyroiditis
*usually self-limiting, no need to treat!
In which thyroiditis would you see multinucleate giant cells?
DeQuervain Thyroiditis (aka granulomatous thryoiditis!!)
3 months after pregnancy
Enlarged painless thyroid
Otherwise asymptomatic
Histology:
Lymphocytes but no germinal centers, plasma cells, or Hurthle cells
Silent Thyroiditis
Rock-hard, “woody” neck mass?
Reidel’s Thyroiditis
What is Reidel’s Thyroiditis?
Fibroblast proliferate and lay down collagen
Patients may have other glands involved
Hypothyroidism
What is myxedema?
Accumulation of hydrophilic ground substance (glycosaminoglycans) through the connective tissues in the body
Leads to: non-pitting edema Coarsening of facial features Enlargement of tongue Deepening of voice
Do you myxedema with hyper or hypo-thyroidism?
Hypothyroidism!
What is Grave’s disease?
Autoimmune
Ab stimulates TSH receptor
What is the triad for Grave’s Disease?
- Hyperthyroidism
- Opthalmopathy (lid lag + exopthalmos)
- Dermopathy (pretibial myxedema)
On histology if you saw crowed follicular epithelial cells form that form papillae and scalloped borders, what would you think?
Grave’s Disease
