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55 Cards in this Set

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  • Back
Antibodies in patients with Graves Disease
Thyroid stimulating antibodies (TSAb)
Thyroid stimulating blocking antibodies (TSBAb)
Anti-thyroid peroxidase (TPOAb)
Anti-TGAb (anti-thyroglobulin antibodies)
Anti-iodide symporter
Anti-components of eye muscle and/ or fibroblasts
Antibodies to DNA
Antibodies to parietal cells (infrequent)
Antibodies binding to platelets
Three diseases share same immunological changes, histology & genetic predisposition:
1) graves
2) ?
3) ?
Graves dis, AITD, idiopathic failure

(AITD, characterized by goiter and various degrees of hypothyroidism
Idiopathic “atrophic” hypothyroidism is a result of AITD, and myxedema is most advanced form of disease)
In the three diseases, antibodies & cell-mediated immunity are directed against:
TSH receptor (megalin), thyroid peroxidase& thyroglobulin
In pts with ophthalmopathy, antibodies against components of _____ _____ and fibroblasts are formed
orbital muscles
Pathogenesis of Graves Disease:

Three sets of antibodies are produced:
TSAb: thyroid-stimulating & acts similar to TSH

TSBAb: thyroid stimulating blocking antibody – blocks binding of TSH, but not stimulatory by itself

Third set neither blocks nor stimulates thyroid function (TBII: thyrotropin binding inhibitory immunoglobulins

TSAb mediates the thyroid activity and hypersecretion seen in Graves Dis
B cells produce what antibodies to cause Graves disease?
anti-TSH receptor IgG
What is the thyroid hormone feedback circuit?
thyroid hormone tells pituitary to stop production of TSH.
Describe the onycholysis of thyrotoxicosis
Distal separation of the nail plate from the nail bed (Plummner's nails)
Thyroid gland, acropachy (clubbing of fingers)
Pretibial myxedema
Thyroid gland, Localized myxedema (pretibial)
Other Causes of Hyperthyroidism
Toxic nodular goiter
Follicular adenoma
Solitary “hot” nodule
TSH-mediated thyrotoxicosis
Pituitary tumor
Pituitary resistance to thyroid hormone
HCG-mediated hyperthyroidism
Hydatidiform mole
Other HCG-related tumors
Thyroid carcinoma (rare)
Thyroid gland, nodular goiter, hyperthyroidism
Heart problem assoc with Graves
pericardial effusion

acute necrosis of myocardium
Autoimmune thyroiditis. Note: Clusters of Hurthle cells
in sea of lymphocytes
Bands of fibrous tissue in autoimmune thyroiditis.
Autoimmune thyroiditis in nodular goiter
What causes collections of lymphocytes in the gland and is responsible for epithelial cell damage?
thyroid autoimmunity
Progression of disease can change picture from “goitrous” hypothyroidism to “_______” thyroiditis (known as primary hypothyroidism)
Alternative cause of “atrophic” hypothyroidism is development of ________ Abs
thyroid stimulation blocking antibodies (TSBAb)
thyroid stimulation blocking antibodies (TSBAb) Prevents TSH binding to TSH-R, but do not stimulate thyroid cells to produce _____
Proposed that TSBAb binds to one end of TSH-R, while thyroid stimulating antibodies (TSAb) bind to ______
opposite end of TSH-R
A predominant TSAb response results in ______
A predominant TSBAB response results in _______
HLA antigens of hypothyroid pts with TSAb were different from pts with Hashimoto thyroiditis & idiopathic myxedema and more similar to pts with ______ disease
Thyroid dysfunction may be induced by ______-mediated apoptosis of thyroid epithelial cells
___ lymphocytes may not be directly involved in thyrocyte cell death
______ DNA, a feature of apoptosis, was found frequently in autoimmune thyroiditis
Ligand for Fas (Fas L), expressed on thyrocytes, induced by IL-1alpha, which is abundantly produced in thyroid gland of Hashimoto thyroiditis, induces ___ expression on thyrocytes
_______ interaction on thyrocytes may induce apoptosis & destruction of thyroid cells
Fas & FasL strongly stained in follicular cells which suggests that cytokines induce up-regulation of ______-
Increased serum TSH may inhibit ____-mediated apoptosis of thyrocytes
In contrast, _____ blocks inhibitory action of Fas-mediated apoptosis and induces thyroid atrophy
In relation to Fas-FasL system, mutations of Fas, which induce loss of function, found in thyroid lymphocytes of 38% of pts with ______ thyroiditis

(Additionally, in 64% of pts with malignant lymphoma)
There is a relationship of AIT to malignant ______
Antithyroglobulin autoantibody stains colloid
Antimicrosomal antibody stains follicular epithelium
Most common cause of hypothyroidism in American women
Autoimmune Thyroiditis (AIT)
Etiology of AIT?
Etiology unknown
Who is affected by AIT?
Affects older women (45-65 yrs), usually asymptomatic, with goiters (diffuse, non-nodular)
Lab findings in early AIT?
Early laboratory changes: decreased T4, increased TSH
Treatment of AIT?
Lifetime replacement with thyroid hormone
Cancer risk after AIT?
Slightly increased risk for malignant lymphoma of thyroid gland
95% of malignant ______ arise within autoimmune thyroiditis
However, only 5% of patients with AIT are at risk for malignant _____
Radiogram of thyroid of pt
Thyroid is not taking up iodine
Thyroid gland, granulomatous thyroiditis. Note: partial involvement of gland
Thyroid gland, granulomatous thyroiditis.
Note: giant cells & smaller stromal cells
Thyroid gland, granulomatous thyroiditis, giant cell engulfing colloid
Thyroid gland, granulomatous thyroiditis. Inflammatory reaction
against colloid
Thyroid gland, granulomatous thyroiditis, giant cell reaction to colloid
Thyroid gland, FNA, granulomatous thyroiditis, giant cell
Clinical findings to thyroiditis
Severe pain, extreme tenderness in region of thyroid gland.
Malaise, fatigue, myalgia & arthralgia, common
Mild to moderate fever
Disease may peak in 3-4 days & subside within a week
More typical. Onset over 1-2 weeks & continues for 3-6 wks
Symptoms may also extend over many months
Thyroid gland enlarged 2-3 times normal

Tender to palpation

About ½ of pts present with symptoms of thyrotoxicosis: nervousness, heat intolerance, tremors, increased sweating

Thyroid function returns to normal

<10% of pts develop permanent hypothyroidism
Lab findings of thyroiditis
Laboratory findings: striking elevation of ESR

Elevated C-reactive protein

High serum T3, T4, thyroglobulin, low radionuclide uptake, absent or low TG antibodies
Thyroid gland, radionuclide scan, granulomatous thyroiditis