Podcast
Questions and Answers
Which histologic feature differentiates subacute lymphocytic thyroiditis from Hashimoto thyroiditis?
Which histologic feature differentiates subacute lymphocytic thyroiditis from Hashimoto thyroiditis?
- Hürthle cell metaplasia
- Germinal center formation (correct)
- Lymphocytic infiltration
- Extensive fibrosis
In granulomatous thyroiditis, multinucleate giant cells enclose pools of what substance?
In granulomatous thyroiditis, multinucleate giant cells enclose pools of what substance?
- Colloid (correct)
- Fibronectin
- Amyloid
- Calcium
A patient presents with thyroid pain and transient hyperthyroidism. Which type of thyroiditis is the MOST likely diagnosis?
A patient presents with thyroid pain and transient hyperthyroidism. Which type of thyroiditis is the MOST likely diagnosis?
- Subacute lymphocytic thyroiditis
- Granulomatous thyroiditis (correct)
- Hashimoto thyroiditis
- Riedel thyroiditis
A woman develops painless hyperthyroidism two months after giving birth. Which condition is MOST likely?
A woman develops painless hyperthyroidism two months after giving birth. Which condition is MOST likely?
Which of the following is a common long-term outcome of subacute lymphocytic thyroiditis?
Which of the following is a common long-term outcome of subacute lymphocytic thyroiditis?
Propylthiouracil (PTU) is used to manage hyperthyroidism because it inhibits thyroid hormone production. What additional mechanism contributes to its therapeutic effect?
Propylthiouracil (PTU) is used to manage hyperthyroidism because it inhibits thyroid hormone production. What additional mechanism contributes to its therapeutic effect?
What feature is typically observed in granulomatous thyroiditis during microscopic examination?
What feature is typically observed in granulomatous thyroiditis during microscopic examination?
A patient with a history of autoimmune disorders presents with painless goiter and transient hyperthyroidism. Which antibody is MOST likely to be elevated?
A patient with a history of autoimmune disorders presents with painless goiter and transient hyperthyroidism. Which antibody is MOST likely to be elevated?
In individuals with thyroid hyperfunction, high doses of iodide can rapidly decrease thyroid hormone release. What is the primary mechanism behind this effect?
In individuals with thyroid hyperfunction, high doses of iodide can rapidly decrease thyroid hormone release. What is the primary mechanism behind this effect?
Calcitonin, secreted by the parafollicular cells of the thyroid gland, plays a role in calcium regulation. What is its primary action on bone tissue?
Calcitonin, secreted by the parafollicular cells of the thyroid gland, plays a role in calcium regulation. What is its primary action on bone tissue?
Which of the following features is LEAST characteristic of subacute lymphocytic thyroiditis?
Which of the following features is LEAST characteristic of subacute lymphocytic thyroiditis?
A patient with hyperthyroidism is being treated with propylthiouracil (PTU). What biochemical process is directly inhibited by PTU, leading to reduced thyroid hormone synthesis?
A patient with hyperthyroidism is being treated with propylthiouracil (PTU). What biochemical process is directly inhibited by PTU, leading to reduced thyroid hormone synthesis?
A patient presents with symptoms of hyperthyroidism. Which medication would directly block the synthesis of new thyroid hormones?
A patient presents with symptoms of hyperthyroidism. Which medication would directly block the synthesis of new thyroid hormones?
In a patient with Graves' disease (hyperthyroidism), which of the following mechanisms would be the MOST effective in immediately reducing the release of preformed thyroid hormones?
In a patient with Graves' disease (hyperthyroidism), which of the following mechanisms would be the MOST effective in immediately reducing the release of preformed thyroid hormones?
A researcher is studying the effects of a novel drug on thyroid hormone synthesis. The drug decreases the expression of genes regulated by thyroid hormone. At which point in the hypothalamus-pituitary-thyroid axis is this drug MOST likely acting?
A researcher is studying the effects of a novel drug on thyroid hormone synthesis. The drug decreases the expression of genes regulated by thyroid hormone. At which point in the hypothalamus-pituitary-thyroid axis is this drug MOST likely acting?
What is the primary mechanism by which radioactive iodine helps to treat hyperthyroidism?
What is the primary mechanism by which radioactive iodine helps to treat hyperthyroidism?
Which of the following processes is NOT directly involved in thyroid hormone production within the thyroid gland?
Which of the following processes is NOT directly involved in thyroid hormone production within the thyroid gland?
A patient with a thyroid disorder has elevated levels of both T3 and T4, but normal TSH levels. Which of the following could explain this?
A patient with a thyroid disorder has elevated levels of both T3 and T4, but normal TSH levels. Which of the following could explain this?
A patient is diagnosed with autoimmune hypothyroidism. Which of the following is the most likely underlying cause?
A patient is diagnosed with autoimmune hypothyroidism. Which of the following is the most likely underlying cause?
Following thyroid surgery, a patient experiences tingling in their fingers and muscle cramps. Lab results show hypocalcemia. Which of the following is the MOST likely explanation?
Following thyroid surgery, a patient experiences tingling in their fingers and muscle cramps. Lab results show hypocalcemia. Which of the following is the MOST likely explanation?
A patient has elevated levels of anti-thyroglobulin and antithyroid peroxidase antibodies but no symptoms. What condition is the MOST likely to develop?
A patient has elevated levels of anti-thyroglobulin and antithyroid peroxidase antibodies but no symptoms. What condition is the MOST likely to develop?
A newborn is diagnosed with thyroid hypoplasia? Which of the following is the most likely cause?
A newborn is diagnosed with thyroid hypoplasia? Which of the following is the most likely cause?
Which of the following mechanisms is NOT directly involved in thyroid cell death in Hashimoto's thyroiditis?
Which of the following mechanisms is NOT directly involved in thyroid cell death in Hashimoto's thyroiditis?
Which medication would be MOST effective in rapidly alleviating the symptoms of hyperthyroidism related to increased adrenergic tone?
Which medication would be MOST effective in rapidly alleviating the symptoms of hyperthyroidism related to increased adrenergic tone?
Radioactive iodine is contraindicated with?
Radioactive iodine is contraindicated with?
The development of Hashimoto's thyroiditis involves a breakdown in peripheral tolerance to thyroid autoantigens. What is the PRIMARY consequence of this breakdown?
The development of Hashimoto's thyroiditis involves a breakdown in peripheral tolerance to thyroid autoantigens. What is the PRIMARY consequence of this breakdown?
How do genetic factors such as polymorphisms in CTLA4, PTPN22, and IL2RA contribute to the pathogenesis of Hashimoto's thyroiditis?
How do genetic factors such as polymorphisms in CTLA4, PTPN22, and IL2RA contribute to the pathogenesis of Hashimoto's thyroiditis?
In Hashimoto's thyroiditis, what is the fate of the thyroid parenchyma as the disease progresses?
In Hashimoto's thyroiditis, what is the fate of the thyroid parenchyma as the disease progresses?
If a patient is diagnosed with Hashimoto's thyroiditis and also has a family history of type 1 diabetes (T1D), which genetic factor might contribute to both conditions?
If a patient is diagnosed with Hashimoto's thyroiditis and also has a family history of type 1 diabetes (T1D), which genetic factor might contribute to both conditions?
Histological analysis of a thyroid biopsy from a patient with suspected Hashimoto's thyroiditis is performed. Which of the following findings would be MOST indicative of this condition?
Histological analysis of a thyroid biopsy from a patient with suspected Hashimoto's thyroiditis is performed. Which of the following findings would be MOST indicative of this condition?
A researcher is investigating the cytokine profile within the thyroid gland of a patient with Hashimoto's thyroiditis. Which cytokine is MOST likely to be elevated, contributing to the inflammatory process?
A researcher is investigating the cytokine profile within the thyroid gland of a patient with Hashimoto's thyroiditis. Which cytokine is MOST likely to be elevated, contributing to the inflammatory process?
Which of the following best describes the role of CD8+ cytotoxic T cells in the pathogenesis of Hashimoto's thyroiditis?
Which of the following best describes the role of CD8+ cytotoxic T cells in the pathogenesis of Hashimoto's thyroiditis?
A patient presents with a hard, fixed thyroid mass. This clinical presentation most closely mimics which condition?
A patient presents with a hard, fixed thyroid mass. This clinical presentation most closely mimics which condition?
What is the typical duration of the initial hyperthyroid phase in transient thyroiditis if untreated?
What is the typical duration of the initial hyperthyroid phase in transient thyroiditis if untreated?
Which antibody is most commonly associated with Graves disease, found in approximately 90% of patients?
Which antibody is most commonly associated with Graves disease, found in approximately 90% of patients?
In contrast to hyperthyroidism caused by Graves disease, what happens to radioactive iodine uptake in transient thyroiditis?
In contrast to hyperthyroidism caused by Graves disease, what happens to radioactive iodine uptake in transient thyroiditis?
Riedel thyroiditis is associated with fibrosis and tissue infiltration by plasma cells producing which immunoglobulin?
Riedel thyroiditis is associated with fibrosis and tissue infiltration by plasma cells producing which immunoglobulin?
What is the typical age range in which transient thyroiditis most commonly occurs?
What is the typical age range in which transient thyroiditis most commonly occurs?
Which of the following genetic factors is associated with both Graves' disease and Hashimoto's thyroiditis?
Which of the following genetic factors is associated with both Graves' disease and Hashimoto's thyroiditis?
What is the concordance rate of Graves disease in monozygotic twins compared to dizygotic twins?
What is the concordance rate of Graves disease in monozygotic twins compared to dizygotic twins?
In the context of Hashimoto thyroiditis, what characterizes the initial phase of transient thyrotoxicosis (hashitoxicosis)?
In the context of Hashimoto thyroiditis, what characterizes the initial phase of transient thyrotoxicosis (hashitoxicosis)?
Individuals with Hashimoto thyroiditis have an elevated risk for developing which of the following conditions?
Individuals with Hashimoto thyroiditis have an elevated risk for developing which of the following conditions?
How does the pathogenesis of Hashimoto thyroiditis differ from other autoimmune diseases, according to the presented model?
How does the pathogenesis of Hashimoto thyroiditis differ from other autoimmune diseases, according to the presented model?
What macroscopic feature is typically observed in the thyroid gland affected by Hashimoto thyroiditis?
What macroscopic feature is typically observed in the thyroid gland affected by Hashimoto thyroiditis?
Upon histological examination in the early stages of Hashimoto thyroiditis, what cellular characteristic is most likely to be observed?
Upon histological examination in the early stages of Hashimoto thyroiditis, what cellular characteristic is most likely to be observed?
Consider a patient presenting with symptoms suggestive of thyroid dysfunction following a bout of mumps. Which of the following findings would most strongly suggest the presence of Hashimoto thyroiditis triggered by the viral infection?
Consider a patient presenting with symptoms suggestive of thyroid dysfunction following a bout of mumps. Which of the following findings would most strongly suggest the presence of Hashimoto thyroiditis triggered by the viral infection?
A researcher is investigating the immune mechanisms underlying Hashimoto thyroiditis. If their hypothesis is correct that cytotoxic T-lymphocytes (CTLs) cause damage to thyroid follicle cells. Which of the following findings would provide the strongest support for this hypothesis?
A researcher is investigating the immune mechanisms underlying Hashimoto thyroiditis. If their hypothesis is correct that cytotoxic T-lymphocytes (CTLs) cause damage to thyroid follicle cells. Which of the following findings would provide the strongest support for this hypothesis?
A patient with Hashimoto thyroiditis is found to have a firm, yellow-white area within their thyroid gland during a routine ultrasound. Histological examination reveals a monoclonal population of B-cells. This finding most strongly suggests the presence of which of the following complications?
A patient with Hashimoto thyroiditis is found to have a firm, yellow-white area within their thyroid gland during a routine ultrasound. Histological examination reveals a monoclonal population of B-cells. This finding most strongly suggests the presence of which of the following complications?
Flashcards
Propylthiouracil
Propylthiouracil
Blocks thyroid hormone production by inhibiting iodide oxidation and T4 to T3 conversion.
Large doses of Iodide
Large doses of Iodide
Inhibits the proteolysis of thyroglobulin, blocking the RELEASE of thyroid hormones.
Parafollicular cells (C cells)
Parafollicular cells (C cells)
Synthesize and secrete calcitonin.
Calcitonin Function
Calcitonin Function
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Thyroid Hormone Secretion
Thyroid Hormone Secretion
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Hyperthyroidism
Hyperthyroidism
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Thyroid Diseases
Thyroid Diseases
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C Cells
C Cells
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Increased Thyrocytes
Increased Thyrocytes
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Organification of Iodine
Organification of Iodine
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T3 and T4 Formation
T3 and T4 Formation
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β-blocker
β-blocker
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Thionamide
Thionamide
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Iodine Solution
Iodine Solution
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T4 to T3 Conversion Inhibitors
T4 to T3 Conversion Inhibitors
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Hashimoto Thyroiditis
Hashimoto Thyroiditis
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Peripheral Tolerance Breakdown
Peripheral Tolerance Breakdown
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Thyroid Autoimmune Destruction
Thyroid Autoimmune Destruction
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CTLA4, PTPN22, IL2RA
CTLA4, PTPN22, IL2RA
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Autoimmune Disease Overlap
Autoimmune Disease Overlap
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Common Autoimmune Theme
Common Autoimmune Theme
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Thyroid Cell Depletion
Thyroid Cell Depletion
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Lymphocytic Infiltration & Fibrosis
Lymphocytic Infiltration & Fibrosis
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Mechanisms of Thyroid Cell Death
Mechanisms of Thyroid Cell Death
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Painless Thyroiditis
Painless Thyroiditis
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Antibodies in Painless Thyroiditis
Antibodies in Painless Thyroiditis
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Histology of Painless Thyroiditis
Histology of Painless Thyroiditis
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Painless Thyroiditis Progression
Painless Thyroiditis Progression
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Granulomatous Thyroiditis
Granulomatous Thyroiditis
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Granulomatous Thyroiditis Histology
Granulomatous Thyroiditis Histology
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Symptoms of Granulomatous Thyroiditis
Symptoms of Granulomatous Thyroiditis
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Effects of Granulomatous Thyroiditis
Effects of Granulomatous Thyroiditis
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Hashitoxicosis
Hashitoxicosis
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Hashitoxicosis Hormone Levels
Hashitoxicosis Hormone Levels
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Hypothyroid Hormone Levels
Hypothyroid Hormone Levels
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Hashimoto's Associated Autoimmune Diseases
Hashimoto's Associated Autoimmune Diseases
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Hashimoto's Thyroid Gland Appearance
Hashimoto's Thyroid Gland Appearance
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Hashimoto's Cut Section Appearance
Hashimoto's Cut Section Appearance
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Hashimoto's Histologic Changes (Early)
Hashimoto's Histologic Changes (Early)
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Riedel Thyroiditis
Riedel Thyroiditis
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Thyroid-Stimulating Immunoglobulin (TSI)
Thyroid-Stimulating Immunoglobulin (TSI)
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Thyroiditis
Thyroiditis
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Hyperthyroid Phase (Thyroiditis)
Hyperthyroid Phase (Thyroiditis)
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Recovery Phase (Thyroiditis)
Recovery Phase (Thyroiditis)
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TSH Receptor Blocking Antibodies
TSH Receptor Blocking Antibodies
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TSI Mechanism
TSI Mechanism
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Graves Disease
Graves Disease
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Study Notes
- The thyroid gland has two lobes connected by a thin isthmus
- The isthmus is usually located below and anterior to the larynx
- Embryologically, it develops from an evagination of the pharyngeal epithelium
- This evagination descends from the foramen cecum at the base of the tongue to the anterior neck
- Ectopic thyroid tissue can be present at the base of the tongue (lingual thyroid) or other high neck sites due to this descent pattern
- Thin fibrous septae divide the thyroid into lobules
- Lobules consist of 20-40 follicles, lined by cuboidal to low columnar epithelium and filled with PAS-positive thyroglobulin
Role of TSH
- TSH (thyrotropin) is released into circulation by thyrotrophs in the anterior pituitary in response to hypothalamic factors
- Thyroid follicular epithelial cells activate their TSH receptor, associating with a G protein upon TSH binding
- The G protein activation triggers downstream events, increasing intracellular cAMP levels
- Increased cAMP stimulates thyroid growth, hormone synthesis, and release via cAMP-dependent protein kinases
Production of T3 and T4
- Thyroglobulin is converted into thyroxine (T4) and smaller amounts of triiodothyronine (T3) by thyroid follicular epithelial cells
- Released T4 and T3 enter systemic circulation and bind to plasma proteins like thyroxine-binding globulin and transthyretin reversibly
- Serum unbound ("free") T3 and T4 concentrations are maintained within narrow limits by the binding proteins
- Most free T4 gets deiodinated into T3 in the periphery
- Nuclear thyroid hormone receptors in target cells bind to T3 with tenfold greater affinity and proportionately greater activity
- A multiprotein hormone-receptor complex results from thyroid hormone binding to its nuclear receptor (TR)
- Thyroid hormone response elements (TREs) near target genes are assembled by the hormone-receptor complex, increasing transcription
Effects of Thyroid Hormones
- Thyroid hormone has diverse cellular effects
- These include stimulating carbohydrate and lipid catabolism and protein synthesis in a wide range of cells
- An increase in the basal metabolic rate is the net result of thyroid hormone production
- Critical role in brain development in the fetus and neonate
Goitrogens
- Chemical agents known as goitrogens can inhibit thyroid gland function
- TSH levels increase, causing hyperplastic gland enlargement (goiter) due to suppressed T3 and T4 synthesis
Medication
- Oxidation of iodide is inhibited and thyroid hormone production is blocked by the antithyroid agent propylthiouracil
- Furthermore, propylthiouracil inhibits the peripheral deiodination of circulating T4 into T3, limiting thyroid hormone excess symptoms
- The release of thyroid hormones is blocked by large iodide doses by inhibiting thyroglobulin proteolysis in individuals with thyroid hyperfunction
- Thyroid hormone is synthesized and incorporated into colloid but not released into the blood
C cells
- The thyroid gland follicles also have a population of parafollicular cells, or C cells
- Calcitonin, a hormone that promotes calcium absorption by the skeletal system and inhibits bone resorption by osteoclasts is synthesized and secreted by C cells
Thyroid Diseases
- Conditions such as hyperthyroidism (excess release of thyroid hormones), hypothyroidism (thyroid hormone deficiency), and mass lesions can affect the thyroid
- Clinical consequences of disturbed thyroid function are considered first, followed by the disorders that generate those problems
Hyperthyroidism
- Thyrotoxicosis is a hypermetabolic state caused by elevated circulating levels of free T3 and T4
- Hyperthyroidism is often used to refer to thyrotoxicosis because it is frequently caused by hyperfunction of the thyroid gland
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