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Endocrinology > Thyroid Pathology > Flashcards

Thyroid Pathology Flashcards

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1
Q

is thyroid bigger in men or women

A

slightly larger in women

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2
Q

what level is the thyroid

A

C5/6-T1

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3
Q

describe the embryological development of the thyroid gland

A

develops from evagination of pharyngeal epithelium

descends from foramen caecum to normal location along the thryoglossal duct

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4
Q

what are the three common embryological abnormalities of the thryoid

A

failure of descent (lingual thyroid)
excessive descent (retrosternal location in mediastinum)
thyroglossal duct cyst

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5
Q

what makes up the thyroid

A

composed of follicles that are surrounded by flat cuboidal follicular epithelial cells

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6
Q

what is in the centre of each follicle

A

dense amorphic pink material containing thryoglobulin

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7
Q

what cells are scattered throughout the thyroid gland

A

C cells (parafollicular)- have slightly larger with clearer cytoplasms

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8
Q

what do C cells produce

A

calcitonin- lowers serum Ca

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9
Q

what cells produce thyroid hormones

A

thyroid follicular epithelium cells

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10
Q

describe how TSH works

A

binds to TSH surface receptor on surface of thyroid epithelial cells. G proteins activated with conversion of GTP to GDP and production of cAMP which stimulates production and release of T3 and 4, circulate in bound and free forms

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11
Q

what happens when T3 binds to receptors in target cells

A

complex translocates to the nucleus, binds to thyroid response elements on target genes, stimulates transcription of these genes- increase BMR

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12
Q

what can cause a thyroid gland to shrink in size

A

atrophy- presentation of reduced function a

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13
Q

what can a mass effect if an enlarged thyroid gland be

A

airway obstruction

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14
Q

polymorphisms in what genes are associated with autoimmune thyroid problems

A

CTLA-4 (negative regulator of T cell responses)

PTPN-22 (inhibits T cell function)

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15
Q

what are causes of inflammation in the thyroid

A

autoimmune disordersm infection, palpation, subacute lymphocytic, de Quervains, riedels

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16
Q

what does riedels do to the thyroid

A

makes it hard, claggy

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17
Q

what autoimmune disease causes hypothyroidism

A

hashimotos thyroiditis

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18
Q

what autoimmune disease causes 8% of hyperthyroidism cases

A

graves disease

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19
Q

what is thyrotoxoicosis

A

hyperthyroidism

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20
Q

what else can cause hyperthyroidism

A

hyperfunctioning nodules, tumours (adenomas, carcinomas)
TSH secreting pituitary adenomas (rare),
thyroditis, ectopic production (struma ovarii)

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21
Q

is graves more common in men or women

A

women 10:1

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22
Q

what age to people gets graves

A

20-40 years old

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23
Q

what is the triad of symptoms seen in graves

A

hyperthyroidism with diffuse enlargement of the thryoid
eye changes (exophthalamos),
partial myxoedema

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24
Q

what autoantibodies are seen in graves

A

Antibodies to TSH receptor, thyroid peroxisomes and thyroglobulin.

Anti TSH receptor antibodies: thyroid stimulating immunoglobulin, thyroid growth stimulating immunilogbulin,
TSH binding inhibitor immunoglobulins

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25
what do the antibodies in graves do
stimulate thyroid hormone to function- except TSH binding inhibitor which causes episodes of hypofunction seen in graves
26
what is seen histologically in graves
thyroid follicles lack the 'pink collar' of follicular cells aka scalloping due to uptake of colloid
27
what causes symptoms in hypothyroidism
lack of thyroid hormones
28
who gets hashimotos
middle aged women
29
what genes is hashimotos associated
HLA- DR3 and DR5
30
what else can cause hypothyroidism
iodine deficiency, drugs (lithium), post therapy (surgery, irradiation), congenital abnormalities
31
what is hashimotos thyroiditis
autoimmune disease which causes gradual failure of thyroid function
32
what antibodies are in hashimotos thyroiditis
anti thyroid antibodies (anti thyroglobulin and anti peroxidase) when bound cause anti body dependent cell mediated cytotoxicity
33
what cells mediate hashimotos thyroiditis
CD8 +ve cells (destroy cell epithelium) cytokine mediated cell death (gamma interferon from T cell activation recruits macrophages that may damage thyroid follicles)
34
what is the histology of hashimotos
follicles that remain dont have scalloping as retention of thyroid hormone inflammatory infiltrate
35
what might hashimotos thyroiditis be preceded by
transient hyperfunction (hashitoxicosis)
36
what cancer is at increased risk in hashimotos thyroiditis
B cell non hogkins lymphoma
37
what is a goitre
any enlargement of the thyroid gland
38
what commonly causes goitres
lack of dietary, reduced T3/4 production causing rise in TSH which stimulates gland enlargement
39
who gets diffuse goitres
females more than men, puberty and young adults
40
what causes a diffuse goire
ingestion of substances limiting T3/4 production, dyshormogenesis, idiopathic (most)
41
what are the usual symptoms of a goitre
usually euthyroid | presents with mass effects- cosmesis, airway obstruction, dysphagia, compresses vessels
42
what can dyshormogenesis cause in children
cretinism
43
what is seen in blood test in diffuse goitres
normal thyroid hormones but increase or upper side of normal TSH
44
what causes a multinodular goitre
recurrent hyperplasia and involution, mutations in TSH, rupture of follicles, haemorrhage, scarring, calcification
45
what do many multi nodular goitres develop
autonomous nodule- hyperthyroid
46
describe the structure of a thyroid adenoma
discrete solitary mass, encapsulated by a surrounding collagen cuff, composed of neoplastic thyroid follicles (follicular adenoma)
47
are thyroid adenomas benign
yes
48
what is it hard to differentiate a thyroid adenoma from
dominant nodule in multinodular goitre, follicular carcinoma
49
what are the effects of an adenoma
mass effects | usually non functional- can secrete thyroid hormones (thyrotoxicosis)- are TSH independent
50
what mutations are seen in thyroid adenomas
<20% have mutant ras or PIK3CA mutations of TSHR signalling pathway in functional adenomas -activating TSHR, G proteins which increases cAMP levels
51
what cells do thryoid malignancies come from
follicular epithelium (medullary from C cells)
52
list the thyroid malignancies from most to least common
papillary (75-85%), follicular, medullary, anaplastic
53
what is the aetiology of each of the thryoid cancers
environment-radiation (papillary), iodine deficiency (follicular) genetics- papillary- activate MAP kinase pathway, activation of BRAF, mutation in ras follicular- mutations in ras family anaplastic- above + p53 and beta-catenin mutations medullary- MEN2
54
what is the most common thyroid malignancy
papillary
55
what is the usual structure of papillary carcinomas
usually solitary, can be mutlifocal, often cystic, may be calcified (psammoma bodies)
56
do papillary carcinomas spread via the lymph
yes if find thyroid tissue or psammoma body in a lymph node look for occult papillary carcinoma
57
how do papillary carcinomas present
lesion in thyroid gland or cervical lymph node mass (metastasis) ``` local effects: -hoarseness -dysphagia -cough -dyspnoea (all suggest locally advanced disease) ```
58
do papillary carcinomas spread via the lung
not usually- if they do its commonly to the lung
59
what is the second most common thyroid carcinoma
follicular
60
who gets follicular carcinomas
F>M, older than papillary (40s and 50s)
61
when is there not a female predominance in thyroid carcinomad
childhood and old age
62
what are the survival rates for papillary carcinoma
95% at 10 years
63
follicular carcinomas: onset, character and spread
slowly enlarging, painless, non functional, invasive growth pattern dont spread via the lymph (unlike papillary) but spread haematogenous spread to the bones lungs and liver
64
describe the structure of widely invasive follicular carcinomas
more solid architecture, less follicular architecture, more mitotic activity
65
describe the structure of minimally invasive follicular carcinomas
follicular architecture (well differentiated), may have surrounding capsule, hard to distinguish from adenoma
66
what is the difference between follicular adenoma and carcinoma
carcinoma need vascular or capsular invasion
67
what is the prognosis for follicular carcinoma
depends on extent of invasion and stage of presentation if high stage at presentation 50% mortality at 10 years less invasive 90% at 10 years
68
what is autoimmune thyroiditis
hashimotos
69
what type of tumour is a medullary thyroid carcinoma
neuoendocrine (derived from C cells)
70
what can medullary thyroid carcinoma secrete
calcitonin
71
what are the forms of medullary thyroid carcinoma
can be specific, associated with multiple endocrine neoplasm, familial
72
what type of medullary thyroid carcinoma can arise in very young patients
MEN cases
73
who gets sporadic and familial medullary thyroid carcinoma
40s-50s
74
what form do sporadic medullary carcinomas take
solitary nodules
75
what form do familial medullary carcinomas take
bilateral/ multicentric (c cell hyperplasia)
76
what is the histology of medullary carcinomas
spindle or polygonal cells arranged in nests, trabeculae or follicles associated amyloid deposition
77
what paraneoplastic syndromes are seen in medullary carcinomas
diarrhoea (VIP production) | cushings (ACTH production)
78
what is the treatment for medullary carcinoma
total thyroidectomy
79
what is the survival rates for medullary carcinoma
70-80% in 5 years
80
what are the good prognostic factors for medullary carcinoma
young, female, familial setting, tumour size, confined to the gland
81
what histological features suggest a tumour with more aggressive behavior
necrosis, many mitosis, small cell morphology
82
describe anaplastic carcinomas
undifferentiated and aggressive tumours rapid growth an involvement of neck structure and death
83
who gets anaplastic carcinomas
older patients | people with a history of differentiated thyroid cancer

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