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70 Cards in this Set

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What are the characteristic signs / symptoms of hypothyroidism?
- Cold intolerance (↓ heat production)
- Weight gain, ↓ appetite
- Hypoactivity, lethargy, fatigue, weakness
- Constipation
- ↓ Reflexes
- Myxedema (facial / periorbital)
- Dry, cool skin with coarse, brittle hair
- Bradycardia, dyspnea on exertion
What are the characteristic signs / symptoms of hyperthyroidism?
- Heat intolerance (↑ heat production)
- Weight loss, ↑ appetite
- Hyperactivity
- Diarrhea
- ↑ Reflexes
- Pretibial myxedema (Graves disease), periorbital edema
- Warm, moist skin with fine hair
- Chest pain, palpitations, arrhythmias, ↑ number and sensitivity of β-adrenergic receptors
How do patients with hypothyroidism vs hyperthyroidism compare in terms of their bowel habits?
- Hypothyroidism: constipation
- Hyperthyroidism: diarrhea
How do patients with hypothyroidism vs hyperthyroidism compare in terms of their reflexes?
- Hypothyroidism: decreased reflexes
- Hyperthyroidism: increased reflexes
How do patients with hypothyroidism vs hyperthyroidism compare in terms of myxedema (swelling of the skin and underlying tissues giving a waxy consistency)?
- Hypothyroidism: facial and periorbital myxedema
- Hyperthyroidism: pretibial myxedema (Graves disease), periorbital edema
How do patients with hypothyroidism vs hyperthyroidism compare in terms of their skin and hair?
- Hypothyroidism: dry, cool skin with coarse, brittle hair
- Hyperthyroidism: warm, moist skin with fine hair
How do patients with hypothyroidism vs hyperthyroidism compare in terms of cardiac symptoms?
- Hypothyroidism: bradycardia and dyspnea on exertion
- Hyperthyroidism: chest pain, palpitations, arrhythmias, ↑ number and sensitivity of β-adrenergic receptors
Why do patients with hyperthyroidism sometimes have chest pain, palpitations, and arrhythmias?
↑ number and sensitivity of β-adrenergic receptors
What are the lab findings associated with hypothyroidism?
- ↑ TSH (sensitive for 1° hypothyroidism)
- ↓ free T3 and T4
- Hypercholesterolemia (due to ↓ LDL receptor expression)
What are the lab findings associated with hyperthyroidism?
- ↓ TSH (if 1°)
- ↑ free or total T3 and T4
- Hypocholesterolemia (due to ↑ LDL receptor expression)
How do thyroid disorders affect cholesterol? Mechanism?
- Hypothyroidism: hypercholesterolemia due to ↓ LDL receptor expression
- Hyperthyroidism: hypocholesterolemia due to ↑ LDL receptor expression
What is the most common cause of hypothyroidism in iodine-sufficient regions?
Hashimoto Thyroiditis
What causes Hashimoto Thyroiditis?
Auto-immune disorder
- Anti-thyroid peroxidase and anti-thyroglobulin antibodies
- Associated with HLA-DR5
What is there increased risk of in patients with Hashimoto Thyroiditis?
Non-Hodgkin Lymphoma
What may be an early, contradictory finding seen in patients with Hashimoto Thyroiditis?
May be hyperthyroid early in course due to thyrotoxicosis during follicular rupture
What are the histologic findings of Hashimoto Thyroiditis?
Hürthle cells, lymphoid aggregate with germinal centers
Hürthle cells, lymphoid aggregate with germinal centers
What does this histology indicate?
What does this histology indicate?
Hürthle cells, lymphoid aggregate with germinal centers → Hashimoto Thyroiditis
What are the expected thyroid findings on physical exam in a patient with Hashimoto Thyroiditis?
Moderately enlarged, non-tender
The presence of Hürthle cells should make you think of what?
Hashimoto Thyroiditis
Hashimoto Thyroiditis
What can cause severe fetal hypothyroidism (congenital hypothyroidism)?
- Maternal hypothyroidism
- Thyroid agenesis
- Thyroid dysgenesis (most common cause in US)
- Iodine deficiency
- Dyshormonogenic goiter
What are the findings of a patient with congenital hypothyroidism?
6 P's:
- Pot-bellied
- Pale
- Puffy-faced child
- Protruding umbilicus
- Protuberant tongue
- Poor brain development
6 P's:
- Pot-bellied
- Pale
- Puffy-faced child
- Protruding umbilicus
- Protuberant tongue
- Poor brain development
What is cretinism?
Congenital hypothyroidism
What is the most common cause of congenital hypothyroidism in the US?
Thyroid Dysgenesis
What is wrong with the child on the left (before) and after treatment on the right?
What is wrong with the child on the left (before) and after treatment on the right?
Congenital hypothyroidism
Congenital hypothyroidism
What is the term for the self-limited hypothyroidism often following a flu-like illness?
Subacute Thyroiditis (de Quervain)
What happens in Subacute Thyroiditis (de Quervain)?
- May be hyperthyroid early in course
- Self-limited hypothyroidism often following a flu-like illness
What is the appearance of the thyroid histologically in Subacute Thyroiditis (de Quervain)?
Granulomatous inflammation
What cause of hypothyroidism is associated with a very tender / painful thyroid?
Subacute Thyroiditis (de Quervain)
*de QuerVAIN is associated with PAIN*
What are the findings in Subacute Thyroiditis (de Quervain)?
- ↑ ESR
- Jaw pain
- Early inflammation
- Very tender thyroid
- Granulomatous inflammation of thyroid
What causes granulomatous inflammation of the thyroid?
Subacute Thyroiditis (de Quervain)
What disease causes the thyroid to be replaced with fibrous tissue? What does this cause?
Riedel Thyroiditis - causes hypothyroidism
What happens in Riedel Thyroiditis?
- Thyroid replaced by fibrous tissue (hypothyroid)
- Fibrosis may extend to local structures (eg, airway), mimicking anaplastic carcinoma
What is Riedel Thyroiditis considered a manifestatoin of?
Manifestation of IgG4-related systemic disease
What are the findings of a patient's thyroid in Riedel Thyroiditis on physical exam?
- Fixed
- Hard (rock-like)
- Painless goiter
What are some other causes of hypothyroidism?
- Iodine deficiency
- Goitrogens
- Wolff-Chaikoff effect
- Painless thyroiditis
What are the causes of hyperthyroidism?
- Toxic multinodular goiter
- Graves disease
- Thyroid storm
What pathology is associated with focal patches of hyper-functioning follicular cells that work independently of TSH due to a mutation in the TSH receptor?
Toxic Multinodular Goiter
Toxic Multinodular Goiter
What is wrong in Toxic Multinodular Goiter?
- Focal patches of hyper-functioning follicular cells
- Work independently of TSH due to mutation in TSH receptor
- ↑ Release of T3 and T4
- Focal patches of hyper-functioning follicular cells
- Work independently of TSH due to mutation in TSH receptor
- ↑ Release of T3 and T4
What does this histologic image of the thyroid show?
What does this histologic image of the thyroid show?
Toxic Multinodular Goiter
- Follicles of various sizes distended with colloid (black arrows)
- Follicles are lined by flattened epithelium with areas of fibrosis and hemorrhage (blue arrows)
- Nodules are rarely malignant
Toxic Multinodular Goiter
- Follicles of various sizes distended with colloid (black arrows)
- Follicles are lined by flattened epithelium with areas of fibrosis and hemorrhage (blue arrows)
- Nodules are rarely malignant
What is the term for thyrotoxicosis when a patient with iodine deficiency suddenly is made iodine replete?
Jod-Basedow Phenomenon
What happens in the Jod-Basedow Phenomenon?
Thyrotoxicosis if a patient with iodine deficiency goiter is made iodine replete
What is the most common cause of hyperthyroidism?
Graves disease
What is the underlying pathophysiology responsible for Graves disease?
Auto-antibodies (IgG) stimulate TSH receptors on thyroid, retro-orbital fibroblasts, and dermal fibroblasts
What kind of antibodies are associated with Graves disease? Hashimoto Thyroiditis?
- Graves disease: IgG auto-Abs that stimulate TSH receptors
- Hashimoto Thyroiditis: anti-thyroid peroxidase and anti-thyroglobulin auto-Abs
What are the implications of auto-antibodies (IgG) stimulating the TSH receptors on the thyroid?
- Hyperthyroidism
- Diffuse goiter
What are the implications of auto-antibodies (IgG) stimulating the TSH receptors on retro-orbital fibroblasts?
Exophthalmos: proptosis, extraocular muscle swelling
Exophthalmos: proptosis, extraocular muscle swelling
What are the implications of auto-antibodies (IgG) stimulating the TSH receptors on dermal fibroblasts?
Pretibial myxedema
When does Graves disease often present?
During stress (eg, childbirth)
What is the name for the stress-induced catecholamine surge seen as a serious complication of Graves disease and other hyperthyroid disorders?
Thyroid Storm
What causes a Thyroid Storm?
Stress-induced catecholamine surge seen as a serious complication of Graves disease and other hyperthyroid disorders
What are the symptoms of a Thyroid Storm?
- Agitation
- Delirium
- Fever
- Diarrhea
- Coma
- Tachyarrhythmia (cause of death)
What lab value is possibly elevated in Thyroid Storm? Why?
↑ ALP due to ↑ bone turnover
How do you treat Thyroid Storm?
Treat with the 3 P's:
- β-blockers (eg, Propranolol)
- Propylthiouracil
- Corticosteroids (eg, Prednisolone)
What are the indications for thyroidectomy?
Treatment option for thyroid cancers and hyperthyroidism
What are the potential complications of thyroid cancer?
- Hoarseness: due to recurrent laryngeal nerve damage
- Hypocalcemia: due to removal of parathyroid glands
- Transection of inferior thyroid artery
What are the types of thyroid cancers?
- Papillary carcinoma
- Follicular carcinoma
- Medullary carcinoma
- Undifferentiated / anaplastic carcinoma
- Lymphoma
If you see this on a sample of the thyroid, what diagnosis do you need to think of?
If you see this on a sample of the thyroid, what diagnosis do you need to think of?
Papillary Carcinoma of the thyroid
- Empty appearing nuclei ("Orphan Annie" eyes)
Papillary Carcinoma of the thyroid
- Empty appearing nuclei ("Orphan Annie" eyes)
What is the most common type of thyroid cancer? Associations?
- Empty-appearing nuclei (Orphan Annie eyes), psamomma bodies, nuclear grooves
- Increased risk with RET and BRAF mutations and childhood irradiation
- Excellent prognosis
What are the histologic findings of Papillary Carcinoma of the thyroid?
- Empty-appearning nuclei ("Orphan Annie" eyes)
- Psammoma bodies
- Nuclear grooves
- Empty-appearning nuclei ("Orphan Annie" eyes)
- Psammoma bodies
- Nuclear grooves
What can increase your risk of getting Papillary Carcinoma of the Thyroid?
- RET mutations
- BRAF mutations
- Childhood irradiation
Which types of thyroid cancer are associated with a good prognosis?
- Papillary Carcinoma (excellent prognosis, most common type)
- Follicular Carcinoma (good prognosis)
Which type of thyroid cancer has a very poor prognosis?
Undifferentiated / Anaplastic Carcinoma of thyroid
What are the characteristics of a Follicular Carcinoma of the thyroid?
- Good prognosis
- Invades thyroid capsule (unlike follicular adenoma)
- Uniform follicles
What type of thyroid cancer arises from parafollicular "C cells"?
Medullary Carcinoma of the thyroid
What is the origin of Medullary Carcinoma of the thyroid? What does it produce?
- From parafollicular "C cells"
- Produces calcitonin
If you see this on a sample of the thyroid, what diagnosis do you need to think of?
If you see this on a sample of the thyroid, what diagnosis do you need to think of?
Medullary Carcinoma of the thyroid
- Solid sheets of cells with amyloid deposition (arrow)
- Amyloid stroma
Medullary Carcinoma of the thyroid
- Solid sheets of cells with amyloid deposition (arrow)
- Amyloid stroma
What is Medullary Carcinoma of the thyroid associated with?
- MEN 2A and 2B
- RET mutations
What type of thyroid cancer is more common in older patients?
Undifferentiated / Anaplastic Carcinoma of thyroid
What are the characteristics of Undifferentiated / Anaplastic Carcinoma of thyroid?
- Affects older patients
- Invades local structures
- Very poor prognosis
Which type of thyroid cancer is associated with Hashimoto thyroiditis?
Lymphoma