Endocrine Disorders Quiz

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Questions and Answers

Which of the following is NOT a primary cause of hypothyroidism?

Hashimoto thyroiditis

Pituitary dysfunction (correct)

Iodine deficiency

Iatrogenic factors

What characterizes Hashimoto's thyroiditis?

It involves cytotoxic T lymphocytes attacking the thyroid. (correct)

It affects only young children.

It is caused by iodine deficiency.

It leads to hyperthyroidism solely.

What is a common symptom of hypothyroidism in adults?

Cold intolerance (correct)

Intellectual disability

Cretinism

Impaired skeletal development

What is the histological feature of Hashimoto's thyroiditis?

Lymphocytic infiltration with germinal centers (A) Signup and view all the answers

Which type of thyroiditis is typically associated with a viral upper respiratory infection?

De Quervain's thyroiditis (D) Signup and view all the answers

Which characteristic is NOT associated with MEN type 2A (Sipple syndrome)?

Primary hyperparathyroidism (B) Signup and view all the answers

What distinguishes Familial Medullary Thyroid Cancer from MEN type 2A?

Absence of parathyroid hyperplasia (D) Signup and view all the answers

Which of the following is a symptom of MEN 2B?

Marfanoid habitus (D) Signup and view all the answers

What is the recommended procedure for patients carrying a germline RET mutation?

Prophylactic thyroidectomy (C) Signup and view all the answers

What is the general rate of tumor occurrence in MEN syndromes compared to sporadic neoplasms?

Young age with more aggressiveness (A) Signup and view all the answers

What symptom is NOT typically associated with hypercalcaemia?

Numbness and tingling (D) Signup and view all the answers

Which of the following is a classic sign of hypocalcaemia?

Trousseau’s sign (A) Signup and view all the answers

What is the most common manifestation of MEN type 1?

Primary hyperparathyroidism (A) Signup and view all the answers

Which condition is characterized by a congenital absence of the parathyroid glands?

DiGeorge syndrome (B) Signup and view all the answers

What genetic defect is associated with MEN type 1?

MEN1 gene (A) Signup and view all the answers

Which of the following symptoms is a cardiovascular manifestation of hypocalcaemia?

Prolonged QT interval (A) Signup and view all the answers

What is described by 'painful bones, renal stones, abdominal groans and psychic moans'?

Hypercalcaemia (D) Signup and view all the answers

Which symptom is a classic sign of hyperparathyroidism?

Constipation (D) Signup and view all the answers

What is the primary characteristic of a simple goitre?

Diffuse enlargement without abnormal function (B) Signup and view all the answers

Which of the following is NOT a common cause of thyroid nodules?

Excess T3/T4 production (B) Signup and view all the answers

What is the significance of a 'cold' nodule in thyroid evaluation?

It is more concerning for a neoplasm. (A) Signup and view all the answers

Which demographic factor is more likely to present with thyroid nodules?

Females older than males (B) Signup and view all the answers

What does the evaluation of thyroid nodules typically include?

Clinical history, imaging, and laboratory tests (A) Signup and view all the answers

How does a multinodular goitre primarily differ from a simple goitre?

It exhibits hypertrophy and hyperplasia of follicles. (C) Signup and view all the answers

What is the purpose of fine needle aspiration biopsy (FNAB) in evaluating thyroid nodules?

It is the primary diagnostic tool for accurate assessment. (C) Signup and view all the answers

What is a common characteristic of endemic simple goitre?

It is often related to low iodine intake. (D) Signup and view all the answers

What is the categorization for a thyroid lesion diagnosed as 'Thy 3'?

Neoplasm possible (B) Signup and view all the answers

Which type of malignant thyroid tumor represents about 5% of thyroid malignancies?

Medullary carcinoma (B) Signup and view all the answers

What is the most common type of thyroid cancer?

Papillary carcinoma (A) Signup and view all the answers

Which of the following is NOT a factor leading to the predisposition of Follicular adenoma?

High cholesterol diet (C) Signup and view all the answers

What treatment is usually recommended for a 'Thy 4' or 'Thy 5' categorized lesion?

Excision (A) Signup and view all the answers

Which benign thyroid condition is characterized by an encapsulated, firm mass?

Follicular adenoma (C) Signup and view all the answers

In papillary carcinoma, which age group is most commonly affected?

20 - 40 years (A) Signup and view all the answers

Which of the following statements about thyroid neoplasms is accurate?

Thyroid lymphoma is a rare malignant neoplasm. (D) Signup and view all the answers

Which hormone is the more active form in thyroid function?

Triiodothyronine (T3) (B) Signup and view all the answers

What is a common cause of primary hyperthyroidism?

Graves’ disease (D) Signup and view all the answers

What condition is characterized by star-shaped follicles and increased lymphocytes in the thyroid gland?

Graves’ disease (A) Signup and view all the answers

What is the primary feature for classifying thyroid tumors?

Histological features (B) Signup and view all the answers

Which symptom is associated with hyperthyroidism in elderly patients?

Apathic hyperthyroidism (D) Signup and view all the answers

What do parafollicular C cells in the thyroid gland produce?

Calcitonin (B) Signup and view all the answers

Which of the following is NOT a typical symptom of hyperthyroidism?

Cold intolerance (B) Signup and view all the answers

Which autoimmune disorder is characterized by the presence of an IgG autoantibody to the TSH-receptor?

Graves' disease (C) Signup and view all the answers

What describes the thyroid enlargement that is general and visible?

Goitre (A) Signup and view all the answers

What is a serious medical emergency associated with abrupt, severe hyperthyroidism?

Thyroid storm (D) Signup and view all the answers

Which of the following conditions is a primary cause of hypothyroidism associated with autoimmune dysfunction?

Hashimoto thyroiditis (B) Signup and view all the answers

What is a common outcome for most patients with De Quervain’s Thyroiditis after 6-8 weeks?

Return to euthyroid state (C) Signup and view all the answers

Which symptom is typically associated with hypothyroidism in children but not necessarily in adults?

Intellectual disability (B) Signup and view all the answers

Which histological feature is characteristic of Hashimoto’s thyroiditis?

Lymphocytic infiltration (D) Signup and view all the answers

What distinguishes primary hypothyroidism from secondary hypothyroidism?

Primary hypothyroidism results from a defect in the thyroid gland. (C) Signup and view all the answers

What is the most significant characteristic that differentiates benign from malignant thyroid nodules?

Change in nodule size over time (A) Signup and view all the answers

Which of the following is a common cause of endemic goitre?

Low iodine intake (A) Signup and view all the answers

What is typically assessed during the ‘triple assessment’ for thyroid nodules?

Clinical evaluation, imaging studies, and pathology evaluation (D) Signup and view all the answers

Which demographic factor is most strongly associated with the risk of developing thyroid neoplasms?

Female gender (D) Signup and view all the answers

In the context of thyroid disorders, what does the term 'cold' nodule imply?

No uptake of radioactive iodine (C) Signup and view all the answers

What condition is most likely to cause thyroid hyperplasia and hypertrophy in a multinodular goitre?

Increased levels of TSH (A) Signup and view all the answers

Which imaging modality provides information about the vascularity of a thyroid nodule?

Ultrasound (D) Signup and view all the answers

What does the presence of haemosiderin in thyroid tissue indicate?

Hemorrhage or prior bleeding (C) Signup and view all the answers

Which of the following features is unique to MEN type 2B compared to MEN type 2A?

Ganglioneuromas of mucosal sites (C) Signup and view all the answers

What is a primary reason for recommending prophylactic thyroidectomy in patients with a germline RET mutation?

To prevent the inevitable development of medullary carcinoma (A) Signup and view all the answers

Which of the following statements regarding MEN syndromes is accurate?

Tumors in MEN syndromes often precede asymptomatic endocrine hyperplasia. (C) Signup and view all the answers

Which characteristic is common to both MEN type 2A and MEN type 2B?

Phaeochromocytoma (C) Signup and view all the answers

Which of the following statements best describes the tumors associated with MEN syndromes compared to sporadic neoplasms?

They arise earlier and tend to be more aggressive. (A) Signup and view all the answers

What symptom is typically associated with hypocalcaemia?

Seizures (D) Signup and view all the answers

Which of the following is a manifestation of hyperparathyroidism typically seen in MEN type 1?

Prolactinomas (D) Signup and view all the answers

What cardiovascular manifestation is associated with hypocalcaemia?

Prolonged QT interval (A) Signup and view all the answers

What neurological symptom is indicative of severe hypocalcaemia?

Seizures (C) Signup and view all the answers

Which statement regarding hypoparathyroidism is correct?

It can occur due to autoimmune disease affecting calcium receptors. (A) Signup and view all the answers

Which sign is associated with hypocalcaemia and involves muscle spasms of the facial area?

Chvostek’s sign (D) Signup and view all the answers

What is the primary characteristic of a Follicular adenoma?

Encapsulated and firm mass (D) Signup and view all the answers

What is the most common cause of chronic primary hyperparathyroidism?

Adenomas of the parathyroid gland (D) Signup and view all the answers

Which type of thyroid cancer is least common?

Anaplastic carcinoma (C) Signup and view all the answers

Which MEN syndrome is characterized by hyperplasia or neoplasia of the parathyroid glands, pituitary, and pancreatic islet cells?

MEN type 1 (A) Signup and view all the answers

In a fine needle aspiration biopsy, what categorization is given to lesions that may be indicative of a neoplasm?

Thy 3 (D) Signup and view all the answers

Which demographic group is most at risk for developing Papillary carcinoma?

Females aged 20 to 40 years (D) Signup and view all the answers

Which of the following factors is associated with a good prognosis in Papillary carcinoma?

Female sex (B) Signup and view all the answers

What is the typical treatment protocol for a 'Thy 4' categorized thyroid lesion?

Surgical excision is usually recommended (A) Signup and view all the answers

What is a common predisposing factor for the development of Follicular adenoma?

Exposure to ionizing radiation (A) Signup and view all the answers

Which type of thyroid malignancy is most frequently associated with lymphatic invasion?

Follicular carcinoma (A) Signup and view all the answers

Which clinical feature is specifically associated with Graves' disease?

Swelling of the retro-orbital tissues (C) Signup and view all the answers

What is the histological feature indicative of Graves' disease?

Star-shaped follicles with little colloid (D) Signup and view all the answers

Which of the following conditions represents a secondary cause of hyperthyroidism?

TSH releasing pituitary adenoma (A) Signup and view all the answers

Which of the following is a limitation of fine needle aspiration (FNA) in thyroid evaluation?

It lacks the ability to provide definitive histological diagnosis. (B) Signup and view all the answers

Which of these symptoms is considered a classic manifestation of 'thyroid storm'?

Abrupt, severe hyperthyroidism (D) Signup and view all the answers

Which demographic factor is strongly associated with the development of Graves' disease?

Age group 15-40 years (B) Signup and view all the answers

What role do parafollicular C cells in the thyroid play?

They secrete calcitonin. (D) Signup and view all the answers

Which of the following accurately describes the concept of euthyroid?

Normal thyroid status without symptoms (B) Signup and view all the answers

Which factors are classified as aetiological in the development of thyroid carcinoma?

Dietary iodine deficiency and family history (B) Signup and view all the answers

What distinguishes a general goitre from a localized nodule?

Goitre is visible due to overall thyroid enlargement. (D) Signup and view all the answers

Study Notes

Endocrine Pathology II - Thyroid and Parathyroid Pathology

The course is for Year 2 Pathology students
The lecturer is Dr Helen Barrett
The date of the lecture is January 10th, 2025

Learning Outcomes

Identify the histological features of a normal thyroid gland
List causes of hypo and hyperthyroidism
Describe and illustrate pathological features of neoplastic and non-neoplastic thyroid lesions (including thyroiditis)
Explain the usefulness and limitations of thyroid FNA
Classify thyroid tumours and outline key clinical features and presentation
List the aetiological factors in the development of thyroid carcinoma
Identify the histological features of normal parathyroid glands
List causes of hypo and hyperparathyroidism
Discuss Multiple Endocrine Neoplasia (MEN)

Endocrine System

Pure endocrine organs include the pituitary, thyroid, parathyroid, and adrenal glands
Endocrine components are in mixed organs such as the pancreas, ovaries, and testes

Disease in Endocrine Organs

Disease in endocrine organs often presents via hyperfunction, hypofunction, or enlargement/mass effect

Thyroid Gland

Develops via the thyroglossal duct
Typically weighs 20-25g
Composed of two large lateral lobes connected by an isthmus
Potential developmental anomalies include aplasia/hypoplasia (rare) and heterotopic thyroid tissue (in unusual locations) as well as thyroglossal duct cysts (near the hyoid bone)

Thyroid Gland - Histologically

Follicular cells produce thyroid hormones
Parafollicular (C) cells produce calcitonin
T3 (triiodothyronine) is more active than T4 (thyroxine)
Thyroid function tests include T4, T3, TSH, and antibodies to thyroid/thyroglobulin

Graves' Disease

An autoimmune disorder causing hyperthyroidism
Predominantly affects females (M:F = 1:5)
Typically develops between the ages of 15 and 40
Often has a familial tendency
involves IgG autoantibodies targeting the TSH receptor, increasing thyroid hormone release
Macroscopically, characterized by diffuse enlargement
Microscopically, displays star-shaped follicles, reduced colloid, increased lymphocytes
Clinical features include hyperthyroidism, exophthalmos (eye bulging), and potential dermopathy (pretibial myxedema)

Hyperthyroidism

Primary causes include Graves' disease, toxic multinodular goitre, toxic adenoma, and toxic carcinoma
Secondary causes include TSH-releasing pituitary adenomas (rare) and other thyroiditis types, as well as exogenous thyroxine ingestion, or struma ovarii (ovarian teratoma)
Symptoms in elderly can include “apathetic hyperthyroidism” and worsened cardiac insufficiency
Generalized symptoms include heat intolerance, weight loss despite increased appetite, tachycardia, palpitations, hypermotile GI symptoms, tremor, irritability, proximal muscle weakness
"Thyroid storm" involves abrupt, severe hyperthyroidism, requiring medical emergency intervention, typically due to underlying Graves' disease

Hypothyroidism

Primary causes include Hashimoto thyroiditis, iodine deficiency, and dyshormonogenic conditions (congenital synthesis defects)
Secondary causes include pituitary/hypothalamic dysfunction
Symptoms in adults generally include apathy, mental sluggishness, intolerance to cold, swelling of face/tongue, hoarseness, and myxedema
Childhood symptoms include these adult symptoms, plus impaired skeletal development, intellectual disability, and cretinism

Hashimoto's Thyroiditis

An autoimmune condition where the immune system attacks the thyroid
Typically occurs in middle-aged individuals, with a predominance in females
Histologically characterized by lymphocytic infiltration, with reactive germinal centers, and cellular changes in follicles
Clinically, may begin as euthyroid, progress to hypothyroid, and rarely show transient hyperthyroidism (Hashitoxicosis).

Thyroiditis

A group of disorders associated with thyroid inflammation
Autoimmune forms like Graves' and Hashimoto's are common
De Quervain's thyroiditis is subacute, granulomatous, often preceded by an upper RTI, and most patients recover euthyroid within 6-8 weeks, often presenting with sudden painful enlargement and fever

Thyroid Enlargement

Common causes include simple/multinodular goitre (diffuse gland involvement, often not associated with abnormal function, potentially due to low iodine intake or goitrogens), hyperplastic nodules, thyroid cysts, and some thyroiditis cases

Thyroid Nodules

Thyroid nodules are common
Can be benign or malignant (primary/metastatic)
Differential diagnoses include hyperplasia, neoplasms, and occasionally thyroiditis
Evaluation usually involves clinical history/exam, blood tests, radiology (ultrasound, radionuclide imaging, rarely CT/MRI), and pathology/fine-needle aspiration biopsy (FNAB)
FNAB categories range from non-diagnostic (Thy 1) to malignant (Thy 5); intermediate classifications are associated with further action (repeat scan, biopsy, etc)

Thyroid FNAs

FNAs classify nodules into categories (Thy 1-5) for diagnosis
Often performed under ultrasound guidance
Diagnostic tool of choice, safe, cost-effective

Thyroid Neoplasms

Benign neoplasms include follicular adenoma (encapsulated, firm, usually <5cm), other variants like Hurthle cell/oncocytic adenoma.
Malignant neoplasms include papillary carcinoma, follicular carcinoma, medullary carcinoma, and anaplastic carcinoma

Papillary Carcinoma

Most common thyroid cancer (~85%)
Commonest age range 20-40, with a 4:1 female to male ratio
Good prognosis, with a 98% 5-year survival rate
Common favorable factors are: female sex, <20 years old, confined to the thyroid, well-differentiated cytologic morphology
Often multifocal, with small whitish nodules, sometimes cystic
Micro features include papillary architecture, pale/optic clear nuclei, overlapping nuclei, nuclear inclusions, nuclear grooves, psammoma bodies
Has a propensity to spread/metastasize to draining lymphatics

Follicular Carcinoma

Accounts for 10-15% of thyroid cancers
Typically occurs in individuals aged 50-60, with a 3:1 female to male ratio
Prognosis depends on invasion extent
Can be minimally invasive (high survival rates) or widely invasive (lower survival rates)
Usually presents as a slowly enlarging painless thyroid nodule
Commonly spreads hematogenously, sometimes to bone marrow
Often characterized by capsular or vascular invasion

Medullary Carcinoma

Accounts for up to 5% of thyroid cancers
A neuroendocrine neoplasm of parafollicular C cells
Often secretes calcitonin
Frequently associated with a distinctive amyloid stroma
A familial component exists (30% of cases), often associated with MEN syndromes
Typically presents macroscopically as single to multiple nodules; microscopically, shows variable appearances (solid, glandular, spindled cells)

Anaplastic Carcinoma

Accounts for less than 5% of thyroid cancers
Primarily affects elderly individuals
Rapid growth into adjacent neck structures
Macroscopically presents as hard, gritty masses
Microscopically, characterized by undifferentiated, giant cells
Poor prognosis, typically fatal within a year

Parathyroid Glands

Derived from pharyngeal pouches
Can be located elsewhere in the anterior mediastinum as well
Typically 2-4 glands (some individuals may have fewer or more)
Typically weigh 35-40 mg each
Contains chief cells (functionally active; main cell type) and oxyphil cells (have a lesser role in function)

Parathyroid Hyperfunction

Primary (most common cause): characterized by PTH overproduction, leading to hypercalcemia (high blood calcium levels)
Causes include adenoma (75-80%); primary hyperplasia (10-15%); and rarely parathyroid carcinoma (<5%)
Common symptoms include painful bones, renal stones, abdominal groans, and psychic moans, characterized by osteoporosis, kidney stones, gut upset, confusion/depression, and occasionally severe weakness
Secondary: due to systemic factors—e.g., kidney insufficiency.
Tertiary: results from long-term secondary hyperplasia.

Parathyroid Hypofunction

Conditions leading to low PTH include surgical removal during thyroid procedures, congenital absence of the gland (e.g., DiGeorge syndrome), primary idiopathic atrophy, and familial hypoparathyroidism.
Symptoms include hypocalcemia (low blood calcium levels), characterized by numbness, tingling, muscle cramps, seizures, and potentially other varied manifestations.

Multiple Endocrine Neoplasia (MEN)

Familial diseases involving multiple endocrine glands, inherited predominantly as autosomal dominant traits.
MEN type 1 (Wermer's): associated with parathyroid, pituitary, and pancreatic tumors.
MEN type 2A (Sipple syndrome): characterized by medullary thyroid cancer, pheochromocytoma, and parathyroid disease.
MEN type 2B: includes medullary thyroid cancer and pheochromocytoma, plus specific extra-endocrine manifestations such as ganglioneuromas and marfanoid habitus.
Tumors arising in these syndromes generally occur earlier than sporadic cases, are often multifocal, and sometimes preceded by an asymptomatic hyperplasia stage.
These have a higher recurrence rate than sporadic cases
Germline RET mutation carriers are advised for prophylactic thyroidectomy.

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Description

Test your knowledge on hypothyroidism, Hashimoto's thyroiditis, and multiple endocrine neoplasia (MEN) syndromes. This quiz covers symptoms, histological features, and genetic defects associated with these conditions. Perfect for medical students and healthcare professionals looking to refresh their understanding of endocrine disorders.