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What's the most likely cause of a warm/cold/hot thyroid nodule?
- Warm = normal
- Cold = hypofuncitonal (possibly mallignant)
- Hot = hyperfunctional (benign)
Which lesions are more worrisome (Sold/Cystic)?
Solid; Cystic are probably adenomatour nodules underoging cystic degeneration
Are papillary carcinomas more likely to be solid or cystic? Encapsulated or Unencapsulated?
Sold (cystics aren't a big deal); unencapsulated (vs. follicular)
What's the low power histological appearance of papillary carcinoma of thyroid?
Papillary formations of tumor cells
What's the characteristic high-power (cellular) histological characteristic for Papillary Carcinoma of thyroid?
Opticlaly clear (orpahn annie nuclei); nucelar groove (intranuclear cytoplasmic inclusions); ; overlappting nuclei; even without papillae
What type of thyroid carcinoma appears with Psammoma bodies?
Papillary Thyroid Carcinoma (pathognomonic); calcified structure as fossilized tips of papillae
What are risk factors specific for papillary thyroid carcinomas?
- Irradiation of head/neck in first 2 decades of life
- Hashimoto thyroiditis
A thyorid nodule with a thick and irregular capsule is characteristic of what type of carcinoma?
What histological pattern is charactersitic of follicular carcinoma of thyroid?
- Small closely packed follicles of colloid
- Absence of papillary structures (psammoma bodies; ground glass nuclei; grooves)
How do you distinguish follicular adenoma from carcinoma?
Invasion into capsule or blood vessles; metastases
What genetic alterations are seen in papillary carcinoma?
RET; BRAF mutations
What genetic alterations are seen in medullary carcinoma?
What's included in MEN IIA Syndrome?
Pheochromocytoma; parathyroid hyperplasia/adenoma; medullary carcinoma
What's included in MEN IIB Syndrome?
Pheochromocytoma; mucocutaneous neuromas; skeletal abnormalities; medullary carcinoma
What cell type is the origin of medullary carcinoma?
C-cells of thyroid (parafollicualr cells)
What's the cell marker for Papillary/Follicular Carcinoma?
What's the cell marker for Medulalr Carcinoma?
What's the metastasis pattern for Papillary vs. Follicular vs. Anaplastic thyroid carcinoma?
- Papillary/Anaplastic - Lymphatic spread
- Follicular/Medullary - Hematogenous spread
What's the prognosis comparison between types of thyroid carcinomas?
Papillary (90%) > Follicular (65%) > Medullary (50%) > Anaplastic (0%)
What type of histological pattern is most common in medullary thyroid carcinoma?
What thyroid carcinoma typically has amyloid present?
Medullary Carcinoma of Thyroid
What's the most common type of thyroid carcinoma to spread and where does it go?
Papillary thyroid carcinoma to a lymph nodule
What's the usuall gross features of Hashimoto Thyroditis?
- Diffusely enlarged thyroid that's firm and rubbery
- Red-brown --> yellow brown
What are the histological characteristics of Hashimoto's Thyroiditis?
- destruction of follicles
- Lymphatic & plasmacytic infliltration --> lymphoid follicles and germinal centers
What's the pathogenesis of Hashimoto's disease?
CD4 T-cells targeting thyroid Ag's are activated post infectionB cell stimulation -> CD8 cells destroy gland
What are Hurthle cells and when are they seen?
- Oxyphilic cells from metaplasia of follicular epithelium (increased mitochondria)
- Hashimoto Thyroiditis
What autoantibodies are present in Hashimoto Thyroidits?
Anti- TPO; thyroglobuli; TSH receptor
What are clinical features of Hypothyroidism?
Generalized Myxedema; cardiomegally; psychiatric issues
What does Hashimoto's increase risk for ?
B-cell lymphomas (MALToma)
What is the cause for a multinodular goiter?
Compensation for:Iodine deficiency; Thyroid hormone synthesis defect; decreased TH synthesis; long standing disease
What are common complications associated with goiter?
Cosmetic; airway obstruction; dysphagia; SVC syndrome
What is Plummer Syndrome and when does it present?
When do you see pretibial Myxedema?
What's the diagnostic test for the cause of Cushing's syndome?
24-urine collection; dexamenthasone suppression test
What would you expect to find from plasma ACTH and high dose dexemethasone suppresion in: Pituitary induced adrenal hyperplasia?
Elevated ACTH; suppression only at high dose
What would you expect to find from plasma ACTH and high dose dexemethasone suppresion in: Adrenal Adenoma?
Low plasma ACTH; no ACTH suppression
What would you expect to find from plasma ACTH and high dose dexemethasone suppresion in: Adrenal Carcinoma
- Plasma ACTH - Low
- No suppression
- Large adrenal neoplasm on CT
What would you expect to find from plasma ACTH and high dose dexemethasone suppresion in: Ectopic ACTH (SC CA)
- Plasma ACTH: very high
- No Suppression
What's the most common cause of Cushing's syndrome?
What's the etiology of Cushing's Disease?
Pituitary caused ACTH adenoma
What factors increase the probablility of malignancy in Cushing's Syndome?
What's the most common endogenous cause of Cushing's desease?
What is Conn's syndrome?
Primary Hyperaldosteronism due to adrenal cortical adenoma (#2 cause of hyperaldosteronism)
What's the most common cause of hyperaldosteronism?
What features are charactersitic of secondary hyperaldosteronism?
Increased aldosterone & increased Renin
What features distinguish adrenal adenoma vs. carcinoma?
What do adrenal tumors look like histologically?
Clear; lipid-laden tumor cells in nests (like RCC)
What's the characteristic clinical triad for Hyperparathyrodism?
Painful bones; stones; abnominal groans; psychic moans
What's the predominat cell type of parathyroid adenoma?
What's the most common cause of hyperparathyrodism?
What are the causes of hypercalcemia?
- Ca injestion; hyperthyroid; hyperparathyroid; Iatrogenic; Multiple Myeloma; Paget disease; Addison's; Neoplasia (Squamous Cell); Zollinger-Ellizon; Extra Vit D; Extra Vit A; Sacroidosis
What's the most common causes of primary hyperparathyrodism?
- 80% - solitary adenoma
- 15% - PTH gland hyperplasia
What do you expect to see histologically in the parathyroid?
Fat cells (they're not present in hyperparathyroidism)
What are common clinical features of hyperparathyroidism?
Peptic Ulcers; Pancreatitis; Kidney Stones (post-renal renal failure)
What's the most common cuase of secondary hyperparathyrodisim?
What's the role of vitamin D?
Stimulates absorption of calcium in gut & bone
What's the etiology of renal failure causing hyperparathyroidism?
Decreased phosphate re-absorption (↑ P); decreased vit D activation; decreased Ca absorption (↓ Ca)
What's the difference between secondary and tertiary hyperPTHism?
Tertiary: automatous PTH hyperfunction following secondary hyperPTHism for a while
What are clinical symptoms of hypoparathyroidism?
Hypocalcemia: increased irritibility; hyperreflexia; Chevostek & Trousseau signs; Cataracts; depression; paranoia; intracranial HTN; arrythmias
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