Thyroid Pathology Flashcards
(32 cards)
symptoms of hyperthyroidism
- loss of weight
- thin
- increased appetite
- diarrhoea
- oligomenorrhea
- heat intolerance
- irritable state
- starring gaze, lid lag (exophthalmos)
- pretibial myxoedema
- warm and sweaty
- tachycardia, AF
symptoms of hypothyroidism
- gain of weight
- mildy obese
- (possibly) poor appetite
- constipation
- oligomerrhea/menorrhagia
- cold intolerance
- mental slowness
- peaches and cream skin
- proximal myopathy
- dry and cool
- bradycardia, pericardial effusion
state the pathologies linked to DIFFUSE GOITRE. (4)
- grave’s disease
- hashimoto’s thyroidits
- granulomatous (DeQuervain) thyroiditis
- simple goitre
state the simple pathologies linked to LOCALISED SWELLING (goitre). (3)
- nodular goitre
- neoplasms
- thyroidits (hashi/deq)
state the common pathologies linked to hyperthyroidism. (4)
- grave’s disease
- hyperplasia
- nodular goitre
- neoplasms
state the common pathologies linked to euthyroidism. (2)
- nodular goitre
- neoplasms
state the common pathologies linked to hypothyroidism. (2)
- hashimoto’s thyroiditis
- congenital anomalies
state the 2 commonest congenital pathologies.
- thyroglossal duct cyst
- abnormal development of thyroid gland
features of thyroglossal duct cyst
- embryonal vestige (retention of underdeveloped parts)
- midline neck cyst
- complicated by infection & malignant change
- treat by complete excision
features of abnormal development of thyroid gland
- associated with aplasia & hyperplasia
- severe intellectual disability
- short stature
- coarse facial features
- protruding tongue
- umbilical hernia
- CRETINISM
where can ectopic thyroid tissue develop?
- upper GI tract
- upper respi tract
- soft tissues of neck
- CVS
state the pathogenesis of diffuse and MNG
can be endemic or sporadic
- endemic -> iodine deficiency -> decreased thyroid hormone production
- sporadic -> dyshormogenetic goitre
THERE WILL BE COMPENSATORY INCREASE IN TSH
1. if HYPERTROPHY AND HYPERPLASIA OF FOLLICULAR CELLS -> ENLARGEMENT OF THYROID GLAND -> simple goitre
2. if RECURRENT (1) -> mng
expand on the morphology of simple (diffuse) goitre
hyperplastic stage -> colloid involution stage
- hyperplastic stage
- diffuse mild enlargement
- crowded columnar cells, pseudopapillae - colloid involution stage
- flattened cuboidal epithelium
- abundant colloid
expand on the morphology of multinodular goitre
- extreme, irregular enlargement
- COMMONEST CAUSE OF GOITRE
- mimics neoplastic disease
- can lead to mass effects (hoarseness of voice, vocal cord palsy, dysphagia)
- toxic goitre -> hyperthyroidism
state the common autoimmune conditions. (4)
- hashimoto thyroiditis
- grave’s disease
- granulomatous thyroiditis
- IgG4 related thyroiditis
HASHIMOTO THYROIDITIS
State pathogenesis of disease and its features.
Pathogenesis:
destruction of self-tolerance to thyroid Ag through…
1. cytotoxic CD8+ T cell mediated apoptosis
2. cytokine-mediated cell-mediated apoptosis
3. sensitisation of CD4+ Th cells to thyroid antigens
4. antibody-dependent cell-mediated cytotoxicity
Features:
- old women disease
- familial marker: HLA-DR3, DR5
HASHIMOTO THYROIDITIS
State the clinical features, macro and micro features and complications.
Clinical features:
1. painless diffuse/localised goitre
2. hypothyroidism
3. preceding transient thyrotoxicosis
4. anti-TPO, anti-TSH, anti-Tg Ab
Macro:
- pale enlarged diffuse gland
- pale yellow firm cut surface
Micro:
- infiltrates: lymphocytes, plasma cells, lymphoid follicles
- fibrosis
- thyroid follicles: hurthle (oncocytic) cell change
Complications:
- high risk of MALT lymphoma
- high risk of other autoimmune disease (type 1 DM, SLE)
GRAVES’ DISEASE
State the pathogenesis of disease and its features.
Pathogenesis:
(Breakdown in Th cell tolerance)
TRAb (TSH receptor autoantibodies) bind to TSH receptor to mimic TSH action and increase release of TH + thyrotropin/TSH-binding inhibitor immunoglobulins (TBII) stimulate thyroid to increase release of TH
Features:
- young and middle aged women
- familial HLA-B8, DR3
- anti-TPO, anti-Tg
GRAVES’ DISEASE
State the clinical features, macro and micro features of the disease.
Clinical features:
- pretibial myxoedema
- infiltrative ophthalmopathy (exolphthalmos)
- hyperthyroidism
- diffuse goitre
- bruit
- wide starring gaze with lid lag
- thyrotoxicosis
Macro:
- symmetric diffuse enlargement
- soft reddish meaty cut surface
Micro:
- lymphoid infiltrate (less than hashi)
- follicular cells tall columnar and crowded
- pale and scalloped colloid
GRANULOMATOUS (DeQuervain) THYROIDITIS
State the pathogenesis of the disease and its features.
Pathogenesis:
Virus induced cytotoxic T lymphocyte response to thyroid antigen -> damage follicular cells
Features:
- short history
- self limiting
- middle-aged women
GRANULOMATOUS (DeQuervain) THYROIDITIS
State the clinical features, macro, and micro features of the disease.
Clinical features:
- pain in the neck, goitre
- mild hyperthyroidism -> hypothyroidism -> euthyroid
- recent URTI
Macro:
- Enlarged firm gland
- Patchy film pale yellowish areas with intervening normal parenchyma
Micro:
- Lymphocytes, Histiocytes
- Multinucleated giant cells (loss of nuclei, engulf colloid)
- Destruction of follicles, neutrolphils, microabscesses
Ig-G4-RELATED THYROIDITIS
State the clinical features, treatment and morphology of the disease.
Clinical features:
- progressive fibrosis
- enlargement and adherence to neck structures
- serum lgG4 raised
- underlying pathology in riedel thyroiditis
Treatment:
- corticosteroid therapy
Morphology:
- lymphoplasmacytic infiltration
State the follicular origin benign neoplasms. (2)
- Follicular adenoma
- Oncocytic adenoma
State the follicular origin malignant neoplasms. (5)
Hint: PF, PD, A
Poor grade:
1. Papillary thyroid carcinoma
2. Follicular carcinoma
High grade:
1. Poorly differentiated thyroid carcinoma
2. Differentiated high grade thyroid carcinoma
Undifferentiated:
1. Anaplastic thyroid carcinoma
