Thyroid Pathology BMS 200

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Questions and Answers

What is a common pathophysiological process involved in the formation of goiter in hypothyroidism?

Increased secretion of calcitonin

Increased thyroid hormone production

Inadequate iodine supply leading to increased TSH (correct)

Decreased peripheral conversion of T4 to T3

Which autoimmune condition is characterized by hyperthyroidism and is associated with the formation of antibodies against TSH receptors?

Subacute thyroiditis

Hashimoto's thyroiditis

Graves disease (correct)

Congenital hypothyroidism

Which complication is most commonly associated with the under-section of thyroid hormones?

Thyroid storm

Myxedema coma (correct)

Increased metabolic rate

Heart palpitations

What is a clinical feature of subacute thyroiditis?

Neck pain that can mimic pharyngitis Signup and view all the answers

What is a hallmark pathophysiological characteristic of Hashimoto's thyroiditis?

Destruction of thyroid follicles by immune cells Signup and view all the answers

Which of the following describes 'silent' thyroiditis?

Typically includes painless goiter with no ESR elevation Signup and view all the answers

Thyroid cancers typically manifest clinical features associated with the overproduction of which hormones?

Thyroid hormones Signup and view all the answers

What is a long-term complication associated with subacute thyroiditis?

15% rate of chronic hypothyroidism Signup and view all the answers

Which of the following is a potential environmental trigger for autoimmune thyroid diseases?

Viral infections Signup and view all the answers

In the early stages of subacute thyroiditis, which type of inflammatory cells predominates?

Neutrophils Signup and view all the answers

What is the primary mechanism of action for levothyroxine in managing hypothyroidism?

Replacement of deficient thyroid hormones Signup and view all the answers

What triggers thyrotoxicosis in subacute thyroiditis?

Destruction of the thyroid follicle Signup and view all the answers

Which thyroid-related condition is commonly caused by improper development of the thyroglossal duct?

Thyroglossal duct cyst Signup and view all the answers

What is the typical duration of mild hypothyroidism in 'silent' thyroiditis?

4-12 weeks Signup and view all the answers

How does the presence of TPO antibodies relate to 'silent' thyroiditis?

They are linked to an increased risk during pregnancy Signup and view all the answers

What might be a cause of goiter in thyroid conditions?

Altered thyroid hormone production Signup and view all the answers

What percentage of thyrotoxicosis cases is caused by Graves' disease?

60-80% Signup and view all the answers

Which age group is most commonly affected by Graves' disease?

Adults aged 20-50 Signup and view all the answers

Which immune-related genes are associated with Graves' disease?

CTLA-4, PTPN22, CD25 Signup and view all the answers

What characterizes the ophthalmopathy associated with Graves' disease?

Proptosis and lid retraction Signup and view all the answers

What environmental factors are thought to precipitate Graves' disease?

Non-specific stresses and smoking Signup and view all the answers

Which of the following is NOT a common clinical feature of Graves' disease?

Hypertension Signup and view all the answers

What is the role of TSH receptor-stimulating immunoglobulins (TSIs) in Graves' disease?

They stimulate the TSH receptor without negative feedback Signup and view all the answers

What skin manifestation is associated with Graves' disease, albeit in a small percentage of patients?

Thyroid dermopathy Signup and view all the answers

Which of the following symptoms is NOT commonly associated with Hashimoto's thyroiditis?

Increased heart rate Signup and view all the answers

What pathological feature is highlighted in the description of Hashimoto's thyroiditis?

Prominent atrophic thyroid follicles Signup and view all the answers

Which neurological symptom is frequently reported in patients with Hashimoto's thyroiditis?

Paresthesias Signup and view all the answers

What hormonal shift commonly occurs in the early phase of Hashimoto's thyroiditis?

Increased thyroid hormone release Signup and view all the answers

What type of edema is often observed in the skin of patients with Hashimoto's thyroiditis?

Myxedema Signup and view all the answers

In Hashimoto's thyroiditis, which cardiovascular condition might develop as the disease progresses?

Congestive heart failure (CHF) Signup and view all the answers

What is a common reproductive issue that can occur in women with Hashimoto's thyroiditis?

Menorrhagia or amenorrhea Signup and view all the answers

Which is the most characteristic aspect of the facial appearance in patients with Hashimoto's thyroiditis?

Preserved lateral eyebrows Signup and view all the answers

What is the most significant clinical feature of myxedema coma related to cardiovascular function?

Bradycardia with low blood pressure Signup and view all the answers

Which of the following factors can precipitate myxedema coma?

Gastrointestinal hemorrhage Signup and view all the answers

Which statement correctly describes the thyroid hormone levels in a patient with low T3 and T4?

Increased TRH resulting in elevated TSH Signup and view all the answers

What best describes cretinism in relation to thyroid hormone deficiency?

Mental and physical developmental delays Signup and view all the answers

In the context of myxedema coma, what is a common neurologic manifestation?

Coma and slowed neurologic progression Signup and view all the answers

What is a typical gastrointestinal symptom presented in myxedema coma?

Nausea and abdominal pain Signup and view all the answers

What is the overall prevalence of myxedema coma in the general population?

0.22 per million individuals per year Signup and view all the answers

What role does increased ADH play in a patient with myxedema coma?

Contributing to hyponatremia Signup and view all the answers

Which condition is often mistaken for the term 'myxedema'?

Non-pitting edema in hypothyroid dermopathy Signup and view all the answers

What is the expected respiratory finding in a patient experiencing myxedema coma?

Obstructive sleep apnea and hypoventilation Signup and view all the answers

Study Notes

Thyroid Pathology Overview

Thyroid disorders include hypothyroidism (autoimmune and iodine deficiency) and hyperthyroidism (Graves' disease, toxic goiter).
Goiter formation occurs in both states due to variations in T3 and T4 secretion and feedback mechanisms involving TRH and TSH.

Hashimoto's Thyroiditis

Characterized by leukocyte infiltration and atrophic thyroid follicles.
Clinical features: fatigue, cold intolerance, slowed mental/physical performance, goiter, macroglossia, and skin changes (myxedema).
Neurological symptoms: paresthesias, cramps, delayed reflexes, higher risk of carpal tunnel syndrome.
Cardiovascular issues: bradycardia, mild hypotension, hypercholesterolemia; advanced disease may lead to congestive heart failure.
Diabetes may manifest as menstrual irregularities and erectile dysfunction in men.

Subacute Thyroiditis (De Quervain's)

Associated with viral infections (e.g., mumps, influenza).
Early stages involve multinucleated giant cells and inflammatory infiltrates, leading to potential transient thyrotoxicosis.
Symptoms include neck pain, fever, and tenderness of the thyroid gland; thyroid function can fluctuate.

Silent Thyroiditis

Typically occurs post-pregnancy, mild thyrotoxicosis lasting 2-4 weeks followed by hypothyroidism for 4-12 weeks.
Goiter is painless with no accompanying fever or elevated ESR; commonly seen in women with prior autoimmunity.

Myxedema and Myxedema Coma

Myxedema refers to severe hypothyroidism, leading to non-pitting edema.
Myxedema coma is a life-threatening condition precipitated by stressors (e.g., infection, trauma) in long-term hypothyroid patients.
Symptoms: severe hypotension, bradycardia, hypoventilation, altered mental status; may progress to coma.

Thyrotoxicosis

Defined by high levels of thyroid hormones; most commonly caused by Graves' disease.
Occurs predominantly in women (20-50 years); characterized by TSH receptor-stimulating immunoglobulins.
Environmental triggers include stressors, iodine intake, and genetic predisposition.

Graves' Disease

Clinical features include thyroid ophthalmopathy (1/3 patients), characterized by exophthalmos and lid retraction.
Dermatopathy may occur, with orange-red plaques on shins.
Pathogenesis involves immune factors and environmental triggers that lead to inflammatory changes in orbital and extraocular tissues.

Thyroid Carcinomas

Include follicular and papillary adenomas, medullary, and anaplastic carcinomas; associated clinical features vary.

Thyroglossal Duct Cysts and Congenital Hypothyroidism

Pathogenesis results in cyst formation; may lead to infection and inflammation.
Congenital hypothyroidism presents early in life with significant impacts on growth and development.

Anti-thyroid Medications and Levothyroxine

Both classes of medications target the underlying pathophysiology of hyperthyroidism (Graves' disease) and hypothyroidism.
Levothyroxine acts by supplementing deficient thyroid hormone levels in hypothyroid patients.

Thyroid Storm and Toxic Multinodular Goiters

Thyroid storm is a severe exacerbation of hyperthyroidism; can lead to cardiac failure and fever.
Toxic multinodular goiters release excess thyroid hormones, complicating treatment.

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Description

This quiz covers the pathophysiological processes involved in goiter formation related to hyperthyroidism and hypothyroidism. It includes discussing clinical features of thyroid hormone imbalances and the pathophysiology of iodine deficiency-related hypothyroidism. Additionally, theories of autoimmune thyroid diseases will be critiqued.