Thyroid pathology

Question 1

Name the 4 B’s of T4 function

Answer 1

Brain development
Bone growth
Beta adrenergic effects
BMR increase

Question 2

Patients lab results: high TSH, high T4. What is the pathology?

Answer 2

secondary/tertiary hyperthyroidism: pituitary or hypothalamus pathology

Question 3

What are some signs and symptoms of hyperthyroidism?

Answer 3

weight loss, heat intolerance, cardiac arrhythmia, neuro-muscular problems: tremors, warm moist skin, diarrhea, lid lag, thyroid storm

Question 4

What are the most common causes of hyperthyroidism?

Answer 4

Graves disease, multi-nodular goiter, thyroid adenoma

Question 5

What are the symptoms of hypothyroidism?

Answer 5

weight gain, fatigue, cold intolerance, bradycardia, myxedema –> hoarse voice, myxedema coma

Question 6

What are the two broad categories causing hypothyroidism?

Answer 6

congenital or acquired

Question 7

Describe thyroiditis

Answer 7

inflammation of thyroid gland
F>M
acute/painful or silent/chronic

Question 8

How do you diagnose thyroiditis?

Answer 8

decreased I (123) uptake

Question 9

What would you see microscopically in a case of Hashimoto’s thyroiditis?

Answer 9

Hurkle cells

Question 10

Describe the pathophysiology of Hashimoto’s thyroiditis?

Answer 10

T cell don’t recognize own thyroid antigens as self, attack thyroid, T cells stimulate B cells to produce antibodies to TSH receptors, thyroglobulin, and peroxidase

Question 11

What is myxedema?

Answer 11

leakage of colloid out of thyroid into peripheral tissues, skin does not yield under pressure

Question 12

Describe DeQuervain’s thyroiditis

Answer 12

large sore thyroid after URI due to increase in CD8 cells causes leakage of follicle cells and foreign body giant cell reaction, not serious

Question 13

Why is Bullseye the horse from Toy Story the symbol for Silent Thryoiditis?

Answer 13

silent and does not cause trouble

painless, slightly large thyroid in post-partum/middle aged women

Question 14

What is the biggest risk with Reidel’s thyroiditis?

Answer 14

rock hard woody-like mass can cause tracheal compression

Question 15

How would you diagnose Grave’s disease?

Answer 15

decreased TSH, increased T4 (primary hyperthyroidism), radioactive scan = diffuse increased uptake, clinical triad

Question 16

What is the clinical triad of Grave’s syndrome?

Answer 16

hyperthyroidism, opthalmopathy, dermopathy

Question 17

What micro path findings are indicative of Grave’s disease?

Answer 17

papillae and scalloped colloid

Question 18

How do you treat Grave’s disease?

Answer 18

treat sx: beta blockers or surgery

treat thyroid over-synthesis: drugs, I (131) ablation, surgery

Question 19

What are three main causes of goiters?

Answer 19

inflammatory thyroiditis
non-inflammatory T4 synthesis defect
Iodide def.

Question 20

You would see signs of cyclic involution and hyperplasia in what thyroid pathology?

Answer 20

multi-nodular goiter

Question 21

What drugs are used to treat/prevent Goiters?

Answer 21

Levothyroxine (T4 analog)

Question 22

What are the three possible pathological findings for fine needle aspirate bx of thyroid?

Answer 22

cancer- remove
just follicles- remove
thyroiditis- treat

Question 23

What is the most common benign neoplasm of the thyroid?

Answer 23

thyroid adenoma

Question 24

What are some possible genetic mutations in thyroid adenoma?

Answer 24

G protein mutation

gain of function mutation

Question 25

You see a salt-and-pepper nucleus on a cytology thyroid sample, what is it?

Answer 25

medullary thyroid carcinoma

Question 26

What differentiates medullary thyroid carcinoma from other cancers of the thyroid?

Answer 26

it is a cancer of the C cells

endocrine cancer as opposed to epithelial in origin

Question 27

What is the “worst” malignant neoplasm of the thyroid?

Answer 27

anaplastic thyroid carcinoma

< 10% 5 yr, usu mets. @ dx.

Question 28

Name 3 things about papillary thyroid carcinoma?

Answer 28

most common malignancy of the thyroid
Orphan Annie nuclei
psammoma bodies (Sand[y])