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42 Cards in this Set
- Front
- Back
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causes of primary hyperthyroidism
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Graves diseas
multinodular goiter adenoma |
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causes of secondary hyperthyroidism
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TSH-secreting pituitary adenoma
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heat intolerant
weight loss nervous, irritable skin is warm, velvety tachycardia, tremors |
thyrotoxicosis
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exophthalmos
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thyrotoxicosis
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complications of thyroid storm
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severe catecholamine release = arrhythmia, death
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causes of primary hypothyroidism
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surgery
radioiodine hasimotos iodine deficiency drugs - lithium |
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apathetic
depressed cold intolerant low libido weight gain despite poor appetite skin doughy, dry deep voice dry brittle hair puffy eyes |
hypothyroidism
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short
mentally retarded coarse face protruding tongue and belly cause? |
low iodine intake by pregnant mom
cretinism |
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what is the defect in Hashimotos?
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auto-antibodies to thyroid peroxidase and thyroglobulin
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what cells mediate Hashimotos?
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macrophages
CD8 CTLs NK cells destroy thyroid follicles |
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50 yo woman
lethargic, depressed HLA-DR3,5 increased risk of what? |
B-cel lymphoma
Hasimotos |
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germinal centers and lymphoid follicles on histology
what happens later? |
fibrosis
atrophy of gland Hurthle cell change squamous metaplasia Hashimotos |
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40 yo woman
recent viral infection what do you see histologically? |
granuolmas and fibrosis
subacute granulomatous (deQuervain's) thyroiditis |
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what type of pts get subacute lymphocytic thyroiditis?
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post-partum
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fibrosis of thyroid and neck
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Reidel Thyroiditis
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types of autoantibodies in Graves
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1. thyroid stimulating Ig (long acting)
2. thyroid GROWTH-stimulating Ig (growth, goiter) 3. TSH-binding inhibitory Ig - transient inhibition of TSHR - hypothyroidism |
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30 yo woman
orange peel texture on shins w/ swelling fast heart rate, chest pain what do you see histologically? |
tall folicular cells w/ papillary infoldings
scalloped colloid Graves disease |
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goiter
prognosis? |
90% benign
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types of goiter
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simple vs. toxic (thyrotoxicosis)
multinodular, single, or diffuse |
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histology: nodules w/ fibrous capsules
- various follicle size, some normal what is it? |
goiter
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risks of malignancy w/ unknown mass?
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solitary
male young prior neck radiation cold in I-123 or Tc99 scan |
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malignant thyroid neoplasms
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papillary carcinoma
follicular medularlly anaplastic lymphoma |
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born near Chernobyl
25 yo female cold on I-123 enlarged cervical nodes and histology features prognosis? |
organ annie eyes
cytoplasm grooves intranuclear pseudo-inclusions psammoma bodies good prognosis |
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BRAF point mutationwhat
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papillary carcinoma
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what is a mutation in papillary carcinoma
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RET-PTC translocation
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what pathway is affected in papillary carcinoma?
what is this associated with? |
MAPK (BRAF mutation)
- worse prognosis - distant metastasis - recurrence |
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2nd most common thryoid carcinoma
how does it metastatasize? |
follicular carcinoma
blood - cervical nodes unusual |
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normal thyroid architecture
thick capsule invade blood vessel mutation? |
RAS
follicular carcinoma |
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neuroendocrine tumor
produces what? |
calcitonin, lowers Ca
medullary carcinoma |
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thyroid tumor part of MEN2A & B
mutation? prognosis? |
RET mutation
50% survival Medullary carcinoma |
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solid, lobulated, trabecular growth
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medullary carcinoma
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round, polygonal, spindled cells
salt and pepper chromatin amyloid |
medullary carcinoma
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70 yo woman
previous multinodular goiter from iodine deficiency highly malignant/invasive rapidly enlarging neck mass type of cells? |
atypical spindled or giant cells
anaplastic carcinoma |
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what does the parathyroid gland response to?
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serum Ca levels
NO ant pit/hypothalamus input |
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most common cause of primary hyperparathyroidism
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parthyroid adenoma
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cause of secondary parathryoidism
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renal failure
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30 yo woman
neck mass increased uptake on sesatmibi scan adenoma pushes normal tissue aside high Ca levels what does it grossly look like? |
1 large gland, other 3 glands atrophy
parathyroid adenoma |
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diff b/w parathyroid hyperplasia and carcinoma grossly?
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hyperplasia: all 4 glands enlarged
carcinoma: tumor in one gland, other three atrophy - men have equal risk |
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all 4 parathyroid glands hypertrophied
ischemia tissue necrosis (calciphylaxis) cause? severity of symptoms? |
renal failure
- can't eliminate PO4, accumulates -> Ca goes down, deposits in vessel walls -> PTH compensates less severe than primary hyperparathyroidism |
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high PTH
pt w/ chronic renal failure recent renal transplant |
tertiary hyperparathyroidism
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bone fractures
kidney stone, blocked urine pancreatitis, GI symptoms lethary proximal weakness |
hypercalcemia
asymptomatic - hyperparathyroidism symptomatic - cancer of breast, kidney, lung |
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brown tumors, hemorrhage debris
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hypercalcemia
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