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81 Cards in this Set
- Front
- Back
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T/F Caloriegenic include increased effect on catecholamines
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TRUE
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T/F thyroid enhances SNS activity by ↓ cAMP response to catecholamines and ↑ ß adrenergic receptor number
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T/F thyroid enhances SNS activity by ↓ cAMP response to catecholamines (FALSE - ↑ in cAMP) and ↑ ß adrenergic receptor number
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What effect does thyroid hormone have on CO?
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increase via, ↑ chronotropy and inotropy
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T/F persisting thyroglossal ducts do not become malignant
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FALSE - they are just like the thyroid with respect to dz mech
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What is the embryonic origin of the parafollicular cells and what is it's product?
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What is the embryonic origin of the parafollicular cells and what is it's product? Origin= neural crest cells… calcitonin
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What type of receptor is found on thyroid hormone?
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What type of receptor is found on thyroid hormone? Steroid receptor --> transcriptional machinery on the 5' end
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Which amino acid is thyroid hormone derived from?
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tyrosine --> thyroxine --> T4, rT3, T3
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Where is most iodine lost?
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kidney
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what are the 3 sources of iodine?
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GI, thyroid hormone B/D, leaking of non hormone iodine from thyroid
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How is iodine imported into thyroid gland, thyroid follicular cells? What suppresses iodine uptake? What stimulates iodine uptake?
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How is iodine imported into thyroid gland, thyroid follicular cells? ATP/ADP transporter… perchlorate, pertechnitate, thocynates (found naturally in rutabaga, cabagge and turnips)… TSH
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What traps iodine in thyroid follicular cells, and what is the name of the enzyme?
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What traps iodine in thyroid follicular cells, and what is the name of the enzyme? Oxidation (Thyroid peroxidase)
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What happen in organification of iodine?
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What happen in organification of iodine? Iodine is bound to thyroglobulin molecule
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Where does organification of iodine occur, what enzyme is required, and what are the possible derivations?
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Where does organification of iodine occur, what enzyme is required, and what are the possible derivations? Location: colloid… enzyme: thyroid peroxidase… MIT, DIT, T3, T4
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What three effects does iodine have on thyroid hormone?
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What two effects does iodine have on thyroid hormone? 1) inhibits secretion of thyroid hormone… 2) Wolff Chaidoff effect, which inhibits organification process… maybe inhibits oxidation too
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Besides iodine, what can inhibit Thyroid peroxidases oxidative and organification activities?
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Besides iodine, what can inhibit Thyroid peroxidases oxidative and organification activities? Thionamids: Propylthiouracil and methimazole
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What does TSH have in common with LH and FSH?
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∂ unit… with different ß unit
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What type of receptor does the TRH-® use?
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phosphatidylinositol bisphosphate hydrolysis and acdtivation of protein kinase C
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At what level does T3 and T4 have a negative feedback effect?
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At what level does T3 and T4 have a negative feedback effect? T3 down regulates the TRH-®, T4 must convert to T3 (in pituitary) to have an inhibitory effect
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What cellular effect does TSH have on the thyroid?
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What cellular effect does TSH have on the thyroid? Increase in cAMP
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which T4-T3 converting enzyme is found in the pituitary (type 1 5'deiodinase or type 2)? What is the significance of this enzyme in the thyroid?
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which T4-T3 converting enzyme is found in the pituitary (type 1 5'deiodinase or type 2)? Type 2… What is the significance of this enzyme in the thyroid? It keeps T3 levels high in the thyroid and prevents TSH elevation despite low circulating T3
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which T4-T3 converting enzyme is found in the periphery (type 1 5'deiodinase or type 2)? Which pathway, to rT3 or T3 is seen in nutritional deprivation?
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which T4-T3 converting enzyme is found in the periphery (type 1 5'deiodinase or type 2)? Type 1… Which pathway, to rT3 or T3 is seen in nutritional deprivation? rT3
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What is the percentage of T4>rT3 and T4>T3?
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What is the percentage of T4>rT3=45% and T4>T3=35%?
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Where does most T4>T3 occur?
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liver and kidney
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where is most T4 excreted and what becomes of the iodine?
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20% bile… reclaimed
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What percentage of conversion of T4>T3 occurs in the thyroid and what percentage in the periphery?
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What percentage of conversion of T4>T3 occurs in the thyroid=20% and what percentage in the periphery=80%
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What percentage of thyroid hormone binds to TBG?
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80% to TBG with 20% bound to albumin and transthyretin
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What can reduce the total amount of thyroid hormone?
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decreased binding proteins, but it will not effect the Total free thyroid hormone
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What conditions increase TGB and with decrease it, and which compete with thyroid hormone for binding: estrogen, androgen, liver failure, acute hepatitis, phenylbutazone, salicylates, X-linked disorder, protein loss, phenothiazines, phenytoin, nephrotic syndromes, pregnancy, GC, malnutrition (wasting), clofibrate
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What conditions increase TGB and with decrease it, and which compete with thyroid hormone for binding: estrogen=↑, androgen=↓, liver failure=↓, acute hepatitis=↑, phenylbutazone=↓, salicylates=competes, X-linked disorders=↓&↑, protein loss=↓, phenothiazines=↑, phenytoin↓ and competes, nephrotic syndromes↓, pregnancy=↑, GC=↓, malnutrition (wasting)=↓, clofibrate=↑
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A patient presents with myxedema (fluid retention: puffiness around the eyes), her skin appears grey, and hoarseness and macroglossia, she complains of coldness, and she has gained weight, her heart cardiac output is decreased. What is her likely diagnosis?
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A patient presents with myxedema (puffiness around the eyes), and hoarseness and macroglossia, she complains of coldness, and she has gained weight, her heart cardiac output is decreased. What is her likely diagnosis? Hypothyroidism
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The hypothyroid patient is found to have Hürthle cells (where thyroid follicles cells use to be), with lymphocytic infiltrates, w/ germinal centers replacing functional tissue, there is eosinophilia, with eccentric nucleus and increased mitochondrial contents, what is the etiology of her hypothyroidism?
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The hypothyroid patient is found to have Hürthle cells (where thyroid follicles cells use to be), with lymphocytic infiltrates, w/ germinal centers replacing functional tissue, there is eosinophilia, with eccentric nucleus and increased mitochondrial contents, what is the etiology of her hypothyroidism? Hashimoto's dz
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The same hypothyroid patient goes home after being treated, she fails to show up for her f/u… months pass, she has decreasd blood oxygen saturation and her cerebral blood flow has led to progressive mental impairment, what is this patient in danger of?
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The same hypothyroid patient goes home after being treated, she fails to show up for her f/u… months pass, she has decreasd blood oxygen saturation and her cerebral blood flow has led to progressive mental impairment, what is this patient in danger of? if left untreated --> myxedema coma
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Given what you know about thyroid disease, which would result in vasodilation and which would result in vasoconstriction, hyper/hypothyroidsim?
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Given what you know about thyroid disease, which would result in vasodilation and which would result in vasoconstriction, hyper/hypothyroidsim? Constriction=hypo (grey or yellow palor)… dilation=hyperthyroidism (flushing)
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A woman has a normal birth, but three weeks after the birth of her son she notices a painless lump in her anterior neck, and feels weakness, hot, sweaty, and feels like her heart is racing What is your diagnosis?
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A woman has a normal birth, but three weeks after the birth of her son she notices a painless lump in her anterior neck. What is your diagnosis? Thyroidititis- transient hyperthyroid
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A woman has a painful nodule in the anterior part of her neck, FNA confirms inflammatory infiltration, and signs of viral infection. She complains of feeling weak, hot, sweaty, she's had weight loss even though she's had an increased appetite. Give a diagnosis.
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A woman has a painful nodule in the anterior part of her neck, FNA confirms inflammatory infiltration, and signs of viral infection. Give a diagnosis: viral subacute thyroiditis
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A woman undergoes radioiodine administration to treat hyperthyroid, she later feels hot and sweaty, weakness, and palpatations. What is her diagnosis? And would she be more or less likely to have vasodilation or vasoconstriction?
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A woman undergoes radioiodine administration to treat hyperthyroid, she later feels hot and sweaty, weakness, and palpatations. What is her diagnosis? Radioiodine administration glandular destruction of her thyoid-->thyroiditis. And would she be more or less likely to have vasodilation or vasoconstriction? vasodilation
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A woman complains of feeling cold, she says she's gained weight, she has puffiness around her eyes, hoarseness and says her tongue feels bigger. You find she has a decreased CO. You suspect a problem with her thyroid and do a fine needle aspiration. There is a change in her follicular cells --> and there is positive test for thyroid peroxidase antibodies. Give a diagnosis.
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A woman complains of feeling cold, she says she's gained weight, she has puffiness around her eyes, hoarseness and says her tongue feels bigger. You find she has a decreased CO. You suspect a problem with her thyroid and do a fine needle aspiration. There is a change in her follicular cells --> and there is positive test for thyroid peroxidase antibodies. Give a diagnosis. Hashimoto's dz
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You are working for Doctors Without Border, you see a pregnant woman with a goiter. What is your tentative diagnosis? What are your concerns for this patient's unborn child?
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You are working for Doctors Without Border, you see a pregnant woman with a goiter. What is your tentative diagnosis? Hypothyroidism due to iodine insufficiency. What are your concerns for this patient's unborn child? Because of iodine deficiency the child is at risk for profound retardation, deafness, mutism, and dwarfism... minimum requirement is 50 mcg iodine/day
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What is the etiology of Hashimoto's disease?
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What is the etiology of Hashimoto's disease? Lymphocytic infiltration with formation of germinal centers… due to Thyroid peroxidase serving as an antigen for antibodies - Autoimune
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What are the three major catagories of causes of goiters?
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What are the three major catagories of causes of goiters? Overstimulation of thyroid, Neoplastic process, infiltrative process
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What are the two subcatagories of causes of goiters that fall under the category of Overstimulation of goiter?
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What are the two subcatagories of causes of goiters that fall under the category of Overstimulation of goiter? TSH driven-Hormone biosynthesis defect. And TSI (thyroid stimulated Ig)-Graves disease
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What are the 3 specific types of TSH driven overstimulation of thyroid due to hormone biosynthesis defects?
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What are the 3 specific types of TSH driven overstimulation of thyroid due to hormone biosynthesis defects? Iodine deficiency, inborn error of hormone synthesis, drug or diet induced impairment of hormone synthesis
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What are the two subcatagories of Neoplastic process causes of goiter? Do all neoplastic goiters lead to cancer?
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What are the two subcatagories of Neoplastic process causes of goiter? Uninodular and multinodular… not all lead to cancer
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What are the three Infiltrative processes that cause goiter?
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What are the three Infiltrative processes that cause goiter? Lymphocytic (hashimoto's thyroiditis), amyloid, and fibrous (Riedel's strauma)
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After surgical removal of a malignant thyroid tumor, what treatment should follow? What can be used to screen for recurrence of cancer?
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After surgical removal of a malignant thyroid tumor, what treatment should follow? Radioiodine --> Rx iodine --> prevents TSH overproduction… What can be used to screen for recurrence of cancer? Thyroglobulin measurement with occasional whole body radioiodine scans
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Diagnose the type of thyroid cancer based on these criteria: usually young people (but more aggressive in older people)
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usually young people (but more aggressive in older people) Papillary thyroid tumor
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Diagnose the type of thyroid cancer based on these criteria: usually old
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Diagnose the type of thyroid cancer based on these criteria: usually old --> anaplastic (undifferntiated)
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Diagnose the type of thyroid cancer based on these criteria: Middle aged to old
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Diagnose the type of thyroid cancer based on these criteria: Middle aged to old --> follicular thyroid tumor
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Diagnose the type of thyroid cancer based on these criteria: slow growing with distant metastasis occuring hematogenously
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Diagnose the type of thyroid cancer based on these criteria: slow growing with distant metastasis occuring hematogenously: Follicular thyroid carcinoma
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Diagnose the type of thyroid cancer based on these criteria: lymph node metastasis and slow growing
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Diagnose the type of thyroid cancer based on these criteria: lymph node metastasis and slow growing --> papillary thyroid carcinoma
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Diagnose the type of thyroid cancer based on these criteria:
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Diagnose the type of thyroid cancer based on these criteria: Rapidly growing with extensive lymph node metastasis and distant metastasis
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Diagnose the type of thyroid cancer based on these criteria: Rapidly growing with extensive lymph node metastasis and distant metastasis --> Anaplastic
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Diagnose the type of thyroid cancer based on these criteria: Moderately growing with extensive lymph node metastasis and distant metastasis
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Diagnose the type of thyroid cancer based on these criteria: Moderately growing with extensive lymph node metastasis and distant metastasis --> medullary thyroid carcinom (see MEN II and MEN III)
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A woman appears with a diffusely enlarged mass on her anterior neck. A FNA is performed. Varying sizaed follicles are found with larger follicle filled with colloid. Give her diagnosis.
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A woman appears with a diffusely enlarged mass on her anterior neck. A FNA is performed. Varying sizaed follicles are found with larger follicle filled with colloid. Give her diagnosis. Diffuse non toxic goiter (early stages of multinodular goiter)… no increased risk of neoplasm
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A young woman presents with a cold palpable mass in her anterior neck, with palpable cervical lymph nodes. A FNA is performed. The cells are frond-like, with cuboidal epithelium, there is nuclear atypia, psommoma bodies (concentric calcification). What is her diagnosis? What is her prognosis give lymph node masses?
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A young woman presents with a cold palpable mass in her anterior neck, with palpable cervical lymph nodes. A FNA is performed. The cells are frond-like, with cuboidal epithelium, there is nuclear atypia, psommoma bodies (concentric calcification). What is her diagnosis? Papillary thyroid carcinoma What is her prognosis give lymph node masses? this does not impact prognosis
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A 30 year old woman has bilateral mass in her anterior neck. She's had watery diarrhea, and cushings syndrome. You do a FNA and the finding are spindled cells and C-cell hyperplasia, with amyloid containing stroma. What is her diagnosis. And what is a likely abnormal lab finding you may encounter?
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A 30 year old woman has bilateral mass in her anterior neck. She's had watery diarrhea, and cushings syndrome. You do a FNA and the finding are spindled cells and C-cell hyperplasia, with amyloid containing stroma. What is her diagnosis? Medullary carcinoma... And what is a likely abnormal lab finding you may encounter? Elevated calcitonin levels
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A woman in her 50s presents with a unilateral mass in her anterior neck. She has cushings syndrome. Her lab reports show an elevated calcitonin level. What is her diagnosis? She's heard that cancer can be hereditary and worries about her daughters, what should you advise her?
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A woman in her 50s presents with a unilateral mass in her anterior neck. She has cushings syndrome. Her lab reports show an elevated calcitonin level. What is her diagnosis? Medularry thyroid carcinoma... (sporatic) She's heard that cancer can be hereditary and worries about her daughters, what should you advise her? MEN is often bilateral and tends to appear much younger, but screening can be done for the RET gene.
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A woman appears with a mass on her anterior neck. A FNA is performed. She has asymmetrical enlargement with nodularity and varying sized nodules with cystic degeneration and hemmorage. Give her diagnosis.
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A woman appears with a mass on her anterior neck. A FNA is performed. She has asymmetrical enlargement with nodularity and varying sized nodules with cystic degeneration and hemmorage. Give her diagnosis. Multinodular goiter… no increased risk of cancer
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A 25 year old woman that was previously diagnosed with phaeochromocytoma and parathyroid hyperplasia presents with bilateral mass in anterior neck. What is her diagnosis? Your immediate concer is for metastasis, how would this cancer metastasize?
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A 25 year old woman that was previously diagnosed with phaeochromocytoma and parathyroid hyperplasia presents with bilateral mass in anterior neck. What is her diagnosis? Medullary carcinoma... Your immediate concer is for metastasis, how would this cancer metastasize? both lymphatically and vascularly
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You are not sure if a woman has papillary or follcular carcinoma, you have two clues given in the histology: cells are frond-like and there are psommoma bodies. What is the likely diagnosis?
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You are not sure if a woman has papillary or follcular carcinoma, you have two clues given in the histology: cells are frond-like and there are psommoma bodies. What is the likely diagnosis? Papillary carcinoma
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A 28 year old woman who was previously diagnosed with Lupus and DM II, was complaining of feeling hot, and gittery. She has dermopathy (painful nodules over her tibia and ankles) She has a uniformly enlarged mass in her anterior neck. A FNA is performed, which reveals interstitial lymhocytic infiltrates (lymphoid hyperplasia), and tall columnar follicular epithelium with pseudopapillary buds, a lack of colloid in the follicles. What is your diagnosis? What positive lab result would support this diagnosis?
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A 28 year old woman who was previously diagnosed with Lupus and DM II, was complaining of feeling hot, and gittery. She has dermopathy (painful nodules over her tibia and ankles) She has a uniformly enlarged mass in her anterior neck. A FNA is performed, which reveals interstitial lymhocytic infiltrates (lymphoid hyperplasia), and tall columnar follicular epithelium with pseudopapillary buds, a lack of colloid in the follicles. What is your diagnosis? Graves disease...What positive lab result would support this diagnosis? IgG antibodies to TSH receptor and exopthalmus
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A woman present is a diffuse enlarged, nodular and rubbery goiter. A fine needle aspiration is perfomred. There is destruction of the follicles, with eosinophilic granular cytoplasm. What other symptoms would you be likely to find? What is her diagnosis?
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A woman present is a diffuse enlarged, nodular and rubbery goiter. A fine needle aspiration is perfomred. There is destruction of the follicles, with eosinophilic granular cytoplasm. What is her diagnosis? Hashimoto's thyroiditis What other symptoms would help confirm this diagnosis? hypothyroid symptoms along with myxedema
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A middle aged woman presents with a painless enlargement of her thyroid that is compressing her trachea (and esophagus), a bx is performed and on gross inspection the thyroid is stone hard with fibrosis extending into adjacent soft tissue. What is the diagnosis?
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A middle aged woman presents with a painless enlargement of her thyroid that is compressing her trachea (and esophagus), a bx is performed and on gross inspection the thyroid is stone hard with fibrosis extending into adjacent soft tissue. What is the diagnosis? Riedel's Thyroiditis
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A woman presents with nervousness, and diarrhea, and tremor. You suspect thyroid dysfunction. What is your diagnosis? What TSH level would support this diagnosis?
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A woman presents with nervousness, and diarrhea, and tremor. You suspect thyroid dysfunction. What is your diagnosis? Hyperthyroid… What TSH level would support this diagnosis? Elevated
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A woman presents with painful assymmetrical enlargment in her anterior neck. A FNA reveals an acute microabscess, with follicles filled with neutrophils and granulomatous multinucleated giant celss, macrophages and enlarged follicular cells around pools of colloid. What is the likely cause of this problem? and what is her diagnosis?
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A woman presents with painful assymmetrical enlargment in her anterior neck. She complains of feeling nervous, and feel hot all the time. A FNA reveals an acute microabscess, with follicles filled with neutrophils and granulomatous multinucleated giant celss, macrophages and enlarged follicular cells around pools of colloid. What is the likely cause of this problem? viral infection... and what is her diagnosis? subacute granulomatous thyroiditis (De Quevain's)
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A 63 year old woman complains of hoarseness, stridor and dysphagia. A FNA is performed, which reveals spindle cells, giant cells, and squamoid cells. There is necrosis, and a high mitotic rate with vascular invasion. What is the diagnosis? What is the prognosis?
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A 63 year old woman complains of hoarseness, stridor and dysphagia. A FNA is performed, which reveals spindle cells, giant cells, and squamoid cells. There is necrosis, and a high mitotic rate with vascular invasion. What is the diagnosis? Anaplastic carcinoma of the thyroid... What is the prognosis? months... death is usually due to local invasion
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A 45 year old woman presents with a solitary cold nodule in her thyroid. A FNA is performed, which reveals hypercellular with follicles arranged like an embryonal or fetal follicular adenoma. There is varying degrees of atypia and mitosis, with vascular invasion. What is the diagnosis? What is the likelihood of lymph node metastsis or vascular metastasis?
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A 45 year old woman presents with a solitary cold nodule in her thyroid. A FNA is performed, which reveals hypercellular with follicles arranged like an embryonal or fetal follicular adenoma. There is varying degrees of atypia and mitosis, with vascular invasion. What is the diagnosis? Follicular carcinoma of the thyroid... What is the likelihood of lymph node metastsis or vascular metastasis? No lymph node met... but there is vascular met... as well as distant met
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Which thyroid carcinoma is associated with amyloid?
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Which thyroid carcinoma is associated with amyloid? Medullary
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What is associated with MEN I?
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What is associated with MEN I? Pituitary ademona, parathyroid hyperplasia, and pancreatic islet cell tumors
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What is assoicated with MEN II?
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What is assoicated with MEN II?… Phaeochromocytoma (often bilateral), Meduallary carcinoma of the thyroid, parathyroid hyperplasia
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What is associated with MEN III?
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What is associated with MEN III? Phaeochromocytoma (often bilateral), Meduallary carcinoma of the thyroid, and multiple mucosal neuromas
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What would you expect the ratio of T3:T4 to be in hyperthyroid?
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What would you expect the ratio of T3:T4 to be in hyperthyroid? ↑T3:T4
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What would you expect RAIU to be in hyperthyroidism? When would you see an exception?
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What would you expect RAIU to be in hyperthyroidism? ↑… When would you see an exception? Exogenous thyroid hormone and thyroid gland destruction when thyroid hormone is released acutely
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What are the 3 major catagories of hyperthyroidism?
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What are the 3 major causes of hyperthyroidism? 1) overstimumation of of thyroid (autoimmunity, i.e., Graves dz)… 2) autonomous function of thyroid follicular cells (thyroid nodule or a toxic multinodular goiter), 3) Destruction of thyroid with release of hormones (radioiodine, subacute thyroidititis-viral, transient-postpardom)
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What would you expect T3, T4 and TSH to be in 2° and 3° hypothyroid?
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T3, T4 and TSH to be in 2° and 3° hypothyroid? All decreased
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What would you expect T3, T4 and TSH to be in 1° hypothyroid?
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What would you expect T3, T4 and TSH to be in 1° hypothyroid? T3 ↓, T4 ↓, TSH ↑
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What is the most sensitive and commonly used screening marker used for hyper/hypothyroid?
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What is the most sensitive and commonly used screening marker used for hyper/hypothyroid? TSH
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What would you expect the RAIU to be in
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What is the number one cause of hypothyroid dz in the US?
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Radioidine or surgery
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What is the second most common cause of hypothyroid dz in the US?
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autoimmune dz --> Hashimoto's dz
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What is the adverse drug reaction of long term use of T4 Rx in women?
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What is the adverse drug reaction of long term use of T4 Rx in women? When may have increased bone loss and/or excacerbation of osteoporosis
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What is the dosing recommendation for starting a person on thyroid hormone treatment? What is the exception to this?
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What is the dosing recommendation for starting a person on thyroid hormone treatment? Start off treatment slowly to avoid cardiac arrhythmias or death… What is the exception to this? Myxedma coma (give with GC to meet increased tissue needs, which occur with rapidly accelerated metabolism)
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