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Pathology 2 - Block 3 - Part 4

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davidwurbel7's version from 2016-08-01 01:54

Thyroid 1

Question Answer
The parafollicular or the C cells secrete which inhibits resorption of bone by osteoclastsCalcitonin
These cells secrete calcitonin which inhibits resorption of bone by osteoclastsParafollicular (C Cells)
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Clinical, physiological and biochemical findings in response to elevated thyroid hormone irrespective of cause of elevationThyrotoxicosis
Excess levels of thyroid hormone due to hyperfunctioning of thyroid glandHyperthyroidism
Decreased levels of thyroid hormonesHypothyroidism
Enlargement of thyroid glandGoiter
Enlarged thyroid with nodules in itMultinodular Goiter (MNG)
Enlarged thyroid with nodules with one or more nodules producing thyroid hormoneToxic Multinodular Goiter (MNG)
Benign tumor of thyroid glandAdenoma
Adenoma producing thyroid hormoneToxic Adenoma
Hyperthyroidism due to exogenous administration of thyroid hormoneFactitious Thyrotoxicosis
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Stored as colloid within thyroid folliclesTriiodothyronine (T3) and Thyroxine (T4)
This thyroid hormone is converted to the other if freeThyroxine (T4)
In the blood Triiodothyronine (T3) and Thyroxine (T4) are bound to thisThyroid Binding Globulin (TBG)
The blood levels of free T3/T4 are lowHigh TSH
The blood levels of free T3/T4 are highLow TSH
This reflects hormone that is bound to TBG and is free or metabolically activeTotal Serum T4
Increase in total T4 caused by increase in free T4Primary Hyperthyroidism
Increase in total T4 caused by increase in TBGEstrogen
Decrease in total T4 caused by decrease in free T4Primary Hypothyroidism
Decrease in total T4 caused by decrease in TBGAnabolic Steroids
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Question Answer
Total T4 = Normal Free T4 = Normal TSH = NormalNormal
Total T4 = Elevated Free T4 = Normal TSH = NormalEstrogen Rx
Total T4 = Decreased Free T4 = Normal TSH = NormalAnabolic Steroids
Total T4 = Decreased Free T4 = Decreased TSH = HighPrimary Hypothyroidism
Total T4 = Elevated Free T4 = Elevated TSH = DecreasedPrimary Hyperthyroidism
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Question Answer
Best overall screen for thyroid functionSerum TSH
Primary HyperthyroidismTSH Low
Factitious thyrotoxicosisTSH Low
Secondary HyperthyroidismTSH High
Primary HypothyroidismTSH High
Secondary HypothyroidismTSH Low
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This is structurally similar to TSH and may produce hyperthyroidism by simulating the production of T4Beta-hCG
Evaluates thyroid gland synthetic activityRadioactive Iodine 131
Increased Iodine 131 uptake indicatesIncreased Synthesis of T4
Decreased Iodine 131 uptake indicatesDecrease Synthesis of T4
The iodine used for radioactive iodine uptake testIodine 131
Inactive, do not take up I 131. Normally functioning gland takes up I 131Cold Nodules
Functionally active, takes up I 131. Remainder of gland not seen, since it is suppressedHot Nodules
Thyroglobulin antibodies, thyroid peroxidase antibody, TSH receptor inhibiting antibodies are increased in this conditionHashimoto’s Thyroiditis
This antibody is seen in the most number of case of Hashimoto's Thyroiditis Antiperoxidase Antibodies
Thyroid stimulating immunoglobulin increased in this conditionGraves disease
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Thyroid 2

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Failed descent of thyroid anlage from the base of the tongue. Usually represents all of the thyroid tissueLingual Thyroid
Clinical findings include dysphagia for solids. Mass lesion. Iodine 131 scan locates the lesionLingual Thyroid
Thyroglossal duct fails to atrophy. Cystic midline mass. Infection or carcinoma can occurThyroglossal Ductal Cyst
Increased basal metabolic rate due to this causing increased Na+/K+ ATPase activity, increased oxygen consumption, increased respiration, heat generation and increased cardiovascular activityHyperthyroidism
Ovarian teratoma with ectopic thyroidStruma Ovarii
Order TSH levels when this arrhythmia is present in elderly patientNew Onset Atrial Fibrillation
Proptosis (Exophthalmos), Pretibial myxedema and acropachyGraves' Disease
Thyroid stimulating immunoglobins are present in this conditionGraves' Disease
The IgG that is present in Graves' DiseaseThyroid Stimulating Immunoglobins
This genetic allele is associated with Graves' DiseaseHLA-DR3
Due to glycosaaminoglycans deposited in orbital tissue. Diplopia, conjunctival injection, chemosis, corneal abrasionExophthalmos
Raised and hyperpigmented pretibial areas. Due to excess GAG in the dermisPretibial Myxedema
Separation of nail from nailbedAcropachy
Symptomatic treatment of Graves' Disease is this drugBeta Blockers
Drug that decreases hormone synthesis in Graves' DiseasePropylthiouracil or Methimazole
If not responsive to drug therapy, this can be usedAblative Iodine 131
One or more nodule in MNG become TSH independent. Secretes excess T3 and T4 causing hyperthyroidism. Radioactive scan: hot nodule. Patients do not have signs of Exophthalmos and pretibial myxedemaToxic Goiter
Single nodule in thyroid gland that autonomously release excessive amounts of thyroid hormone. Radioactive scan: hot noduleToxic Adenoma
Hyperthyroidism seen in the elderly. They do not present with typical features of hyperthyroidism instead they have the following Cardiac abnormalities, Atrial fibrillation, CHF and ThyromegalyApathetic Hyperthyroidism
Acute exacerbation of all the symptoms of thyrotoxicosis presenting in a life threatening state secondary to uncontrolled hyperthyroidism – medical emergencyThyrotoxic crisis / Thyroid Storm
Often precipitated by a stressor (infection, trauma or surgery in a hyperthyroid patient)Thyrotoxic crisis / Thyroid Storm
Thyrotoxic crisis / Thyroid storm is treated with thisBeta-Blockers?
Clinical features include Hyperthyroidism, Extreme hyperthermia, tachycardia, vomiting, diarrhea, vascular collapse, hepatic failure, jaundice, Tachy-arrythmia, congestive heart failure, shock and Delirium to coma. Lab investigations: Increased free T3 and T4, Undetectable TSHThyrotoxic Crisis / Thyroid Storm
Clinical syndrome caused by reduced secretion of thyroid hormone. Patients are hypometabolic. Decrease in BMR and decreased sympathetic activity. Normal T4, TSH mildly elevatedHypothyroidism
A tumor with CD 1a markerHistiocytosis
Hypothyroidism manifests as this in older children or adultsMyxedema
Hypothyroidism manifests as this in neonates and infants Cretinism
Early: Fatigue , constipation and cold intolerance, slowing of mental and physical performance. Later: Weight gain: Mental slowness (forgetful), Dry and brittle hair, loss of lateral aspect of eye brow, Deep and hoarse voice, large tongue (macroglossia), Periorbital puffiness, Pretibial myxedema, Slow deep tendon reflexes. Oligomenorrhea and hypercholesterolemiaHypothyroidism
Treatment for hypothyroidismLevothyroxine
Hypothyroidism in infancy or early childhood caused one of the following: Maternal hypothyroidism before development of fetal thyroid gland, Iodine deficiency: during intrauterine and neonatal life. Maternal use of drugs that block thyroid hormone synthesis.Deficiency of enzyme necessary for thyroid hormone synthesisCretinism
Clinical findings include severe mental retardation, increased weight & short stature (dwarfism), Coarse facial features, Protuberant abdomen (pot belly), Enlarged tongue and Umbilical herniaCretinism
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Thyroid 3

Question Answer
Inflammation of thyroid gland caused by microbial pathogens or autoimmune diseases and may result in thyrotoxicosis and eventually hypothyroidismThyroiditis
Autoimmune thyroiditis. HLA DR-5 association. Immune destruction of thyroid gland causing. Initial thyrotoxicosis (due to follicle damage and release of preformed hormone) and eventual hypothyroidism. Most common cause of primary hypothyroidism in North America. Predominantly occurs in womenHashimoto's Thyroiditis
The immune system reacts against a variety of thyroid antigens resulting in the destruction of thyroid gland by Cytotoxic T cells. Anti-thyroid cell antibodies blocking ab formed against TSH receptors resulting in decrease hormone synthesis. Other antibodies that are formed: Anti thyroglobulin ab, anti thyroid peroxidase ab and anti-microsomal abHashimoto's Thyroiditis
Antibodies that are formed: Anti thyroglobulin ab, anti thyroid peroxidase ab, Anti-thyroid cell antibodies and anti-microsomal abHashimoto's Thyroiditis
The most prevalent antibody in Hashimoto's Thyroiditis is thisAnti-Thyroid Peroxidase Antibody
Clinical findings: patients present with painless enlargement of thyroid gland, Initial thyrotoxicosis from gland destruction and Eventual progression to HypothyroidismHashimoto's Thyroiditis
A complication of Hashimoto's Thyroiditis is this condition due to long term inflammationNon Hodgkins B cell Lymphoma of Thyroid
Laboratory findings include High TSH, Low T4 and T3 (Those of hypothyroidism) with the presence of anti thyroid peroxidase antibody and anti-thyroglobulin and antimicrosomal abs.Hashimoto's Thyroiditis
Treatment for Hashimoto's Thyroiditis is thisLevothyroxine
Thyroiditis that follows a viral infection. Presents as tender thyroid gland with transient hyperthyroidism. Gland: enlarged and painfulSubacute granulomatous thyroiditis (de Quervain’s thyroiditis)
Most common cause of painful thyroid glandSubacute granulomatous thyroiditis (de Quervain’s thyroiditis)
Microscopy shows granulomatous inflammation with multinucleated giant cellsSubacute granulomatous thyroiditis (de Quervain’s thyroiditis)
Typically follows a self limited course- does not progress to permanent hypothyroidismSubacute granulomatous thyroiditis (de Quervain’s thyroiditis)
Rare disease characterized by chronic inflammation and extensive fibrous tissue replacement of thyroid gland. Extension of fibrosis into surrounding structuresReidel’s Thyroiditis
Irregular, hard (woody consistency) thyroid gland adherent to surrounding structures. Can present with dyspnea or dysphagia. May mimic anaplastic carcinoma of thyroid. However, patients are younger (40s) and malignant cells are absentReidel’s Thyroiditis
Clinical findings include fever, tender and enlarged thyroid with cervical lymphadenopathy, neutrophilic leukocytosis and signs of Thyrotoxicosis due to gland destruction (resolves after treatment of infection)Acute Thyroiditis
The most common bacteria causing acute thyroiditis is thisStaph aureus
Clinical findings include minimally enlarged thyroid. No pain. Micro: Lymphocytic infiltrate without germinal centersSubacute Painless Lymphocytic Thyroiditis
This condition is usually seen in patients receiving amiodarone, interferon alpha or IL-2Subacute Painless Lymphocytic Thyroiditis
Generalized enlargement of thyroid gland in a euthyroid individual that does not result from inflammatory or neoplastic processGoiter
The most common cause of goiter is thisIodine Deficiency
Characterized by diffuse enlargement without any nodularityDiffuse Nontoxic (Simple) Goiter
Characterized by diffuse enlargement without any nodularity. Associated with iodide deficiency in areas with low iodineEndemic Diffuse Nontoxic (Simple) Goiter
Characterized by diffuse enlargement without any nodularity. Associated with diets rich in goitrogens, puberty, pregnancySporadic Diffuse Nontoxic (Simple) Goiter
A patient presents with diffuse enlargement of the thyroid. Patient states they are vegetarians and they eat large amounts of Brussels sprouts, cabbage, or cauliflowerSporadic Diffuse Nontoxic (Simple) Goiter
Clinical findings include a vast majority euthyroid. Sign and symptoms due to mass effect. T3 and T4 normal , TSH (mildly elevated)Diffuse Nontoxic (Simple) Goiter
Arise from simple goiters due to recurrent episodes of hyperplasia and involution leading to irregular enlargement and nodularityMultinodular Goiter
Complications of this include hemorrhage into cyst, Hoarseness, Dyspnea and stridor and toxic nodular goiterMultinodular Goiter
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Thyroid 4

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Refers to a palpable, discrete swelling (usually >1cm) within an otherwise normal thyroid glandSolitary Thyroid Nodule
In these individuals, the majority of Solitary Thyroid Nodule are colloid filled cysts, foci of thyroiditis or a follicular adenomaWomen
In these individuals, Solitary Thyroid Nodule are more likely to be malignantMen and Children
Discrete, solitary masses. Most derived from follicular epithelium. Some may produce thyroid hormone leading to thyrotoxicosisBenign Tumors of Thyroid
The most common benign tumor composed of follicles surrounded by a complete capsule. Approx. 10% progress to follicular carcinomaFollicular Adenoma of Thyroid
Factors such as history of irradiation to head and neck. Solitary nodule in man or child. Irregular nodule with cervical lymphadenopathy suggest thisMalignancy
This cancer of the thyroid is associated with exposure to radiationPapillary Carcinoma of the Tyroid
This cancer of the thyroid arise from the parafollicular cells (C-cells) of the thyroidMedullary Carcinoma of the Thyroid
Small calcified bodies of dead cancerous cellsPsammonma Body
Psammonma bodies can also be in this cancerPapillary cystic adenocarcinoma of the ovary
Optically clear nuclei appearing in cells of Papillary Carcinoma of the thyroidOrphan Annie Nuclei
The most common cancer of the thyroidPapillary Carcinoma of Thyroid
Follicles lined by malignant cells. Capsular/vascular invasion. Invasion influences prognosis. Hematogenous spreadFollicular Carcinoma of Thyroid
Female dominant cancer. Higher incidence in iodine deficient areas. Follicles invade blood vessels and capsule. Distinction can not be made by FNAC. No psammoma bodies or nuclear features. Hematogenous spread favored location the lungs, boneFollicular Carcinoma of Thyroid
Arises from parafollicular or ‘C’ cells of the thyroid. Amyloid production and may secrete calcitonin, PG, ACTH, serotonin. High levels of calcitonin may cause hypocalcemia. Treatment: Total thyroidectomy, Post op thyroxine, Screen asymptomatic relativesMedullary Carcinoma of Thyroid
Thyroid cancer associated with MEN 2a and MEN 2b due to a mutant in RET geneMedullary Carcinoma of Thyroid
Medullary carcinoma, hyperparathyroidism, pheochromocytomaMEN 2a
Medullary carcinoma,pheochromocytoma, mucosal neuromas (lips/tongue) and marfanoid featuresMEN 2b
More often occurs in elderly women. Often invades local structures leading to dysphagia or respiratory compromise. Rapidly growing tumor. One of the most aggressive and resistant forms of human cancer. Uniformly fatalAnaplastic Carcinoma
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