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58 Cards in this Set

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Describe the embryological origin of the Thyroid gland
Central part is derived from a tubular invagination of the tongue

Lateral Thyroid is derived from the 2nd Pharyngeal Arch
Thyroglossal Duct Cyst
What is seen here?
Thyroglossal Duct Cyst
What is seen here?
Thyroglossal Duct Cyst
-fibrous outer capsule with inner epithelial cells
What is seen here?
Normal Thyroid
-Follicular cells
-inner Colloid
What is seen here?
List the metabolic effects of Thyroid Hormone
1. Uncouples oxidative phosphorylation
-less effective ATP synthesis
-greater heat release

2. Increases Cardiac Output blood volume & Systolic BP
-upregulates Beta-1 receptors in the heart

3. Increases GI motility

4. Increases oxygen consumption by muscle leading to increased muscular activity w/ weakness

5. Promotes Bone Formation
Autoimmune disease characterized by production of IgG autoantibodies to the TSH receptor
Grave's Disease
What are the clinical features of Grave's Disease?
1. Female Dominant age 20-40
2. HLA-DR3 & HLA-B8
3. Hyperthyroidism = weight loss, tachycardia, tremor, sweating, irritability
4. Diffuse Goiter
5. Exophthalmos
6. Pretibial Myxedema = due to excess GAG's in the dermis
Grave's Disease
Dx?
What are the lab findings associated with Grave's Disease?
1. increased serum T4
2. increased Iodine-131 uptake
3. decreased serum TSH
Graves Disease
-large & red
What is this showing?
Graves Disease
-hypercellularity
-reduction in the amount of Colloid
-increased Pinocytosis visualized by the bubbles
What is this showing?
What autoantibodies are associated with Graves Disease?
Anti-microsomal & anti-thyroglobulin
Grave's Disease
-Exophthalmos = due to adipose & GAG's deposited in the orbital tissue
What is the cause of this?
What are 3 complications of Grave's Disease?
1. High-output Heart Failure

2. Exophthalmos

3. Thyroid Storm = palpitations, acute cardiac failure
What is Hypothyroidism in Children called? Adults?
Children = Cretinism

Adults = Myxedema
What are the clinical features of Cretinism?
1. Hypothyroidism
2. Goiter in the "endemic" form = iodine deficiency
3. Pale cold skin with Myxedema
4. Mental retardation = brain requires thyroxine for maturation
5. Stunted growth = required for bone maturation
6. Protruding tongue
What are the causes of Cretinism?
1. Iodine Deficiency = Endemic Type

2. Thyroid aplasia = Sporadic type
What are the clinical features of Myxedema?
1. Hypothyroidism = weight gain, hair loss, delayed DTR's, cold intolerance
2. Coarse, brittle hair
3. Thickening of facial features
4. Muscle weakness
5. Non-pitting myxedema
6. Dilated heart
7. Large tongue
What are the causes of Myxedema?
1. Chronic thyroiditis

2. Surgical resection of thyroid

3. Radiation injury
Myxedema = Adult Hypothyroidism
Puffy eyelids
Enlarged tongue
Scaling of the skin

Dx?
Myxedema
Periorbital Edema & Coarse hair

Dx?
Myxedema
What is seen here?
Myxedema = accumulation of GAG's & hyaluronic acid b/w collagen fibrils of the dermis
What is seen here?
List the 3 major types of Thyroiditis
1. Hashimoto
2. Subacute (deQuervain, granulomatous)
3. Riedel (invasive, firbour, "woody")
Hashimoto's Thyroiditis
-pale & enlarged
What is seen on the right?
Hashimoto's Thyroiditis
-Lymphocytic & plasma cell infiltrate
-germinal centers
-Hurthle cells = epithelial cells with eosinophilic cytoplasm
What is seen here?
Hashimoto's Thyroiditis
-Lymphocytic infiltration
-Colloid depletion in follicles
-Hurthle cells (upper left)
What is seen here?
What are the clinical features of Hashimoto's Thyroiditis?
1. Females > Males; age 40-65
2. painless Goiter
3. Hypothyroidism
4. initial inflammation may cause transient Hyperthyroidism
What is the cause of Hypothyroidism in Hashimoto's Thyroiditis?
IgG autoantibodies block against the TSH receptor = decrease hormone synthesis
Subacute Thyroiditis (de Quervain's, Granulomatous)
-granulomatous inflammation w/ multinucleated giant cells
-self limited
What is seen here?
De Quervain's Subacute Granulomatous Thyroiditis
What is seen here?
What are the clinical features of Subacute Thyroiditis (De Quervain's, Granulomatous)?
1. preceded by Viral infection (Coxsackie)
2. most common in WOMEN age 30-50
3. Tender, firm, enlarged thyroid gland
4. Transient hyperthyroidism
Riedel's Invasive Thyroiditis
What is seen here?
Riedel's Invasive Thyroiditis
-fibrous tissue replacement of the gland
What is seen here?
Rare disease of unknown etiology characterized by destruction of the thyroid gland by dense fibrosis & fibrosis of surrounding structures (trachea & esophagus)
Riedel Thyroiditis
Multinodular Colloid Goiter
What is the cause of this?
Multinodular Goiter
What is this?
Multinodular Goiter
-large follicles filled with Colloid
What is this?
What are the clinical features of Multinodular Goiter?
1. Females > Males
2. frequently asymptomatic
3. Typically EUTHYROID
4. Goiter
Thyroid Adenoma
-completely surrounded by fibrous capsule

**not premalignant
**usually nonfunctional
What is seen here?
Follicular Adenoma
-intact fibrous capsule
What is seen here?
Thyroid Adenoma
-uniform, colloid-filled follicles
What are these cells from?
What are the 4 types of THyroid Carcinoma?
Well differentiated
1. Papillary
2. Follicular

Undifferentiated
3. Medullary
4. Anaplastic
What are Thyroid Carcinoma's usually associated with?
Radiation exposure
Papillary Carcinoma
What is seen here?
Papillary CArcinoma
-papillary pattern intermixed with Follicles
-clear "Orphan Annie eye" nuclei
-Psammoma bodies
What is seen here?
Papillary Adenocarcinoma
-Papillary fronds intermixed with Follicles
-Psammoma bodies (not seen)
-Orphan Annie nuclei = empty-appearing nuclei
What is seen here?
Papillary Adenocarcinoma
-Psammoma bodies = dystophically calcified cancer cell
-Orphan Annie nuclei
What is seen here?
Most common primary thyroid cancer in adults & children
-Female dominant
Papillary Adenocarcinoma
What is the prognosis of Papillary Carcinoma?

What is a common spread site?
Excellent = 90% 20 yr survival

Lymphatic spread to Cervical Nodes
Follicular Adenocarcinoma
What is seen here?
Follicular Carcinoma
-small uniform follicles filled with Colloid
-small projections of malignant cells invading the tumor capsule at the bottom
What is seen here?
Follicular Adenocarcinoma
What is seen here?
Follicular Adenocarcinoma invading a small blood vessel

**Hematogenous metastasis to Lung & Bone
What is seen here?
Anaplastic Carcinoma
-spindle cells
-pleomorphic Giant Cells
-small anaplastic cells
What is seen here?
Anaplastic Carcinoma
What is seen here?
What are the clinical features of Anaplastic Carcinoma?
1. Females > Males; age > 60

2. firm, enlarging, bulky mass

3. dyspnea & dysphagia

4. VERY AGGRESSIVE & FATAL