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Thyroid pathology Flashcards

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1
Q

What are the three embryological abnormalities of the thyroid gland?

A

Lingual thyroid gland
Thyroglossal duct cyst
Retrosternal thyroid gland

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2
Q

How is the thyroid gland arranged histologically?

A

Follicles containing thyroglobulin and lined by follicular epithelium
Scattered C cells/parafollicular cells

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3
Q

What do C cells secrete?

A

Calcitonin

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4
Q

What does calcitonin do?

A

Reduces blood calcium levels (minimally relevant)

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5
Q

Which thyroid-related hormone is secreted from the hypothalamus to act on the anterior pituitary?

A

Thyrotropin releasing hormone

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6
Q

Which thyroid-related hormone is secreted from the anterior pituitary to act on the thyroid?

A

Thyroid stimulating hormone

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7
Q

Which hormones are secreted from the thyroid in response to hormonal stimulation from the pituitary?

A

Triodothyronin (T3)

Thyroxine (T4)

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8
Q

Which specific cells of the thyroid does thyroid stimulating hormone act on?

A

Thyroid follicular epithelium

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9
Q

Which receptor does thyroid stimulating hormone bind to? Where is this receptor found?

A

TSH receptor on follicular epithelium

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10
Q

Which type of receptor is TSH receptor?

A

G-protein coupled receptor

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11
Q

How do G-protein coupled receptors work?

A

Convert GTP to GDP to produced cAMP which increases the production of thyroid hormones

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12
Q

T3 and T4 only circulate when bound to plasma proteins. T/F

A

False - they exist in bound or free forms

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13
Q

How do T3/4 work on target tissues?

A

Bind to target cells >
Bound T3/4-receptor complex translocates to the cell nucleus >
Binding to thyroid response elements on target genes >
Gene transcription and increase in BMR

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14
Q

When might the thyroid gland atropy?

A

When its function is reduced

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15
Q

Enlarged thyroid glands are capable of causing breathing and/or swallowing difficulties. T/F

A

True - if thyroid glands enlarge enough they can cause local mass effects

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16
Q

Define the terms thyrotoxicosis and hyperthyroid

A

Thyrotoxicosis - too much thyroid hormone

Hyperthyroid - hyper function of the thyroid tissues

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17
Q

Is there a genetic component to autoimmune thyroid disease?

A

Yes

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18
Q

What autoimmune condition is associated with autoimmune thyroid disease?

A

Vitiligo

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19
Q

What is the most common cause of hyperthyroidism?

A

Grave’s disease

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20
Q

What is a pituitary cause of thyrotoxicosis?

A

TSH secreting pituitary adenoma

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21
Q

Name a cause of ectopic thyrotoxicosis

A

Struma ovarii

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22
Q

Grave’s disease is autoimmune. T/F

A

True

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23
Q

Is graves disease more common in woman or men?

A

Woman

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24
Q

What age group typically presents with Grave’s disease?

A

20-40 y/o

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25
What are the antibodies against in Grave's disease?
Thyroid stimulating hormone receptor Thyroglobulin Thyroid peroxisomes
26
Name an anti TSH receptor antibody involved in Grave's
Thyroid stimulating immunoglobulin
27
What is the triad of features found in Grave's disease?
Hyperthyroidism with diffuse goitre Exopthalamos (TED) Pretibial myxoedema
28
Why do you get thryoid eye disease in Grave's?
Fibroblasts within the eye and surrounding tissues express TSH receptors
29
What is the most common cause of hypothyroidism?
Hashimoto's thyroiditis
30
Is hashimoto's thyroiditis autoimmune?
Yes
31
Who typically gets Hashimoto's thyroiditis?
Middle aged woman
32
Is Hashimoto's thyroiditis associated with other autoimmune conditions? Is it associated with HLA?
Yes & yes
33
What are secondary and tertiary causes of hypothyroidism?
Pituitary tumour | Hypothalamic tumour
34
What are other causes of hypothyroidism?
Iodine deficiency Lithium medication Iatrogenic (hyperthyroidism treatment)
35
Is hashimoto's thyroiditis more common in woman or men?
Women
36
What is the typical age range who gets hashimoto's thyroiditis?
45-60 y/o
37
Does hashimoto's thyroiditis have a genetic component?
Yes
38
What anti-thyroid antibodies are associated with hashimoto's thyroiditis?
Anti-thyroglobulin | Anti-peroxisome
39
What is hashitoxicosis?
Transient hyperthyroidism that can precede hashimoto's thyroiditis
40
Which two things is hashimoto's thyroiditis associated with?
Autoimmune conditions | B cell non-hodkin's lymphoma
41
What is a goitre?
Enlargement of the thyroid gland
42
Which dietary deficiency is goitre/goitre-producing conditions associated with?
Iodine
43
What is the typical pathogenesis of goitre?
Reduced thyroid hormones > | TSH increased and results in enlarged gland >
44
How does a hypothyroid goitre occur?
Compensation for reduced thyroid hormone fails resulting in hypothyroid goitre
45
What is the term for a state of normal thyroid hormone levels?
Euthyroid
46
Doe males or females get diffuse goitre more commonly?
Females
47
Why might adolescents/young adults present with diffuse goitre?
Dyshormonogenesis (errors of metabolism)
48
How do young patients with diffuse goitre typically present?
Euthyroid with mass effect symptoms (subclinical hypothyroid)
49
What may dyshormonogensis' cause in children?
Cretinism
50
Can multi-nodular goitre evolve from a long standing diffuse goitre?
Yes
51
What mass effects can goitre cause?
Dysphagia Difficulty breathing Vessel compression
52
What is the risk of malignancy with a multinodular goitre?
Low but present
53
Which cells do follicular and papillary thyroid carcinomas come from?
Follicular
54
Which cells does medullary thyroid carcinoma come from?
Parafollicular C cells
55
How do follicular adenomas present?
Discrete solitary mass +/- local symptoms if large
56
Are thyroid adenomas functional?
Most are not | Those which are most often cause hyperthyroid (TSH independent)
57
What is follicular adenoma often mistaken for?
Dominant nodule in multinodular goitre | Follicular carcinoma
58
Do males or females more commonly get thyroid cancer?
Females (apart from children and elderly)
59
When do thyroid cancers present?
Early adulthood
60
What is papillary cancer associated with?
Radiation
61
What is follicular cancer associated with?
Iodine deficiency
62
What is medullary cancer associated with?
Multiple endocrine neoplasia type 2 | Familial medullary cancer
63
What type of goitre does papillary cancer cause?
Solitary thyroid nodule - multifocal, cystic, calcified
64
Does papillary cancer spread by lymph or blood?
Lymph
65
Does follicular cancer spread by lymph or blood?
Blood
66
How does papillary cancer typically present?
Hoarseness Dysphagia Cough Dysphonia
67
What type of goitre does follicular cancer cause?
Slowly enlarging, painless, solitary nodule
68
Where does follicular cancer tend to spread?
Bones, lungs, liver
69
What age group typically gets follicular cancer?
Middle aged
70
How common is medullary thyroid cancer?
Rare
71
What can medullary thyroid cancers secrete?
Calcitonin
72
In which scenario would a medullary cancer arise in a 1) young patient and 2) an adult?
1 - MEN | 2 - Familial/sporadic
73
What is the difference between sporadic and familial medullary cancer cases?
Sporadic - solitary nodule | Familial - bilateral/multicentric
74
How does medullary cancer present?
``` Hoarseness Airway compression Dysphagia Diarrhoea Cushings ```
75
What causes paraneoplastic 1) diarrhoea and 2) cushings?
1 - VIP | 2 - ACTH
76
What is the most aggressive thyroid cancer?
Anaplastic
77
In which age range does anaplastic cancer present?
Elderly
78
Which cancer occurs in people with a history of thyroid cancer?
Anaplastic
79
How is thyroid cancer classified?
``` Th1 - repeat test Th2 - benign Th3 - atypia probably benign Th4 - atypia probably malignant Th5 - malignant ```
80
How many parathyroid glands are there?
4
81
Which cells compose the parathyroid glands?
Chief cells and oxyphil cells
82
What do chief cells secrete and what is its effect?
Parathyroid hormone affecting calcium metabolism
83
What is the most common cause of hyperparathyroidism?
Parathyroid adenoma
84
What is parathyroid hyperplasia associated with?
Multiple endocrine neoplasia 1 & 2
85
What is the difference in terms of gland involvement between parathyroid adenomas and hyperplasia
Adenoma - one gland involved and others atrophic | Hyperplasia - all glands involved
86
What chronic metabolic state can cause secondary hyperparathyroidism?
Hypocalcaemia
87
What are the two most common causes of chronic hypocalcaemia?
Renal failure | Vitamin D deficiency
88
What is tertiary hyperparathyroidism associated with?
Hypercalcaemia
89
What is the presentation of hyperparathyroid disease?
Bone (pain, fracture, osteoporosis) Nephrolithiasis (kidney stones) GI complications (constipations, nausea, gall stones) CNS (depression) Neuromuscular (weakness, fatigue) CVS (calcification of aortic and mitral valves)
90
How common is hypoparathyroid?
Very rare
91
What are the common causes of hypoparathyroid?
Iatrogenic (post-surgery) Di George syndrome (congenital) Familial
92
What are the associations with familial hypoparathyroidism?
Adrenal insufficiency | Mucocutaneous candidiasis
93
How does hypoparathyroid present?
``` Tetany Altered mental state Parkinsonian Raised ICP --> papilloedema Calcification of lens and cataracts Dental abnormalities (if during development) ```

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