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Thyroid Disorders (Thyrotoxicosis (Primary (Graves Disease (Classic Triad,…
Thyroid Disorders
Thyrotoxicosis
Primary
Graves Disease
Classic Triad
Hyperfunctional enlargement of the thyroid
Infiltrative opthalmopathy
Infiltrative dermopathy due to fibroblast deposition
Pathogenesis
Autoimmune
TSI binds TSH
Histology
Papillary infoldings
Scalloping of colloid
Lymphoid infiltrate with germinal centers
Labs
INCREASED T3 and T4
DECREASED TSH
Tx
Beta blockers
PTU
Radioiodine ablation
Toxic multi modular goiter
Toxic Adenoma
Iodine induced
TSH secreting pituitary adenoma
Secondary
Clinical Manifestatons
Increase basal metabolic rate
Tachycardia and palpitations
Muscle weakness and tremors
GI hypermotility
Wide gaze and lid lag
Neoplasms
Likely a cold nodule
Follicular Adenoma
Benign proliferation of follicles surrounded by fibrous capsule
Solid encapsulated mass
May have calcification, necrosis, or hemorrhage
Closely packed microfollicles
Hurthle cells
Lobectomy
Excellent prognosis
Carcinomas
Papillary
Most common
History of radiation exposure
Histology
Psamomma body
Branching papillae with fibrovascular cores
Nuclear grooves
Orphan annie eye cells
Great prognosis
T cell variant has poor prognosis
Whole gland has to come out
RET Mutations
Follicular
Presents 40-60 y/o
INC incidence iodine deficient areas
Invasive and extensive beyond capsule
Mets occur hematogenously
Looks like follicular adenoma
Capsular or vascular invasion
Tx
Total thyroidectomy
radioactive iodine
PI3K/AKT pathway
Medullary
Parafollicular C cells
MEN2A and MEN2B
May secrete VIP/ACTH/calcitonin
Histo
Sheets of malignant cells in amyloid stroma
Use Congo red
appele green bifirengence on polarized light
May present with paraneoplastic syndrome
Anaplastic
Undifferentiated tumors
Poor prognosis/ die within 1 yr
Histo
Giant cells
Mitotic figures
Clinical Presentation
Enlarging mass
Invading other structures
Hoarseness/cough/dysnea
Goiters
Non toxic
No associated with hyperthry
Entire gland is large without nodules
Most patients euthyroid
Multinodular goiter
Asymmetric enlargement
May be toxic or nontoxic
Can grow behind sternum or clavicle
Foci of calcification and fibrosis
FNA to rule out malignancy
.
Thyroiditis
Painful
Infectious thyroiditis
Subacute granulomatous thyroiditis
(De Quervain thyroiditis)
Self limited/ only hyperthyroid for 2 weeks
Enlarged and firm capsule
Multinucleate giant cells
Post viral infection
Little pain
Subacute lymphocytic thyroiditis
Histology
Germinal centers
Lymphocytic infiltrate
Enlarged thyroid
Mild hyperthyroid , but may progress to hyporthyroid
Normally in middle aged women
Reidels Thyroiditis
IgG4 related disease
Adherent
Hard as stone
Hashimotos
Most common cause of hypothyroid
Pathogenesis
Autoimmune destruction of the thyroid
T cell mediated and antibody mediated
Gradual destruction
Labs
Anti TPO
Anti TSHR
Anti iodine receptor
Histology
Enlarged gland
Lymphocytic infiltrate
Hurtle cells (super pink)
Increased risk of B cell lymphoma