Thyroid Pathology Quiz
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Questions and Answers

What is a common result of congenital hypothyroidism?

  • Normal thyroid function
  • Decreased T4 levels (correct)
  • Agenesis of the thyroid gland (correct)
  • Increased T3 levels
  • Which type of thyroid pathology is characterized by the presence of both benign and malignant nodules?

  • Thyroiditis
  • Nodular thyroid disease (correct)
  • Congenital abnormalities
  • Diffuse thyroid disease
  • Which thyroid lab test would be decreased in a patient with hypothyroidism?

  • Thyroid scintigraphy results
  • T4 levels (correct)
  • T3 levels
  • TSH levels
  • What characterizes a 'hot' nodule in thyroid imaging?

    <p>Associated with Graves’ disease</p> Signup and view all the answers

    Which of the following conditions is NOT a form of nodular thyroid disease?

    <p>Aplasia</p> Signup and view all the answers

    What is a characteristic feature of hyperfunctioning thyroid nodules?

    <p>They have increased iodine uptake.</p> Signup and view all the answers

    Which of these conditions may be indicated by a 'cold' nodule on imaging?

    <p>Thyroid carcinoma</p> Signup and view all the answers

    What is thyroid agenesis?

    <p>A complete absence of thyroid gland.</p> Signup and view all the answers

    What is a common risk factor associated with malignant thyroid nodules?

    <p>Exposure to ionizing radiation</p> Signup and view all the answers

    Which of the following congenital abnormalities is characterized by an abnormal location of thyroid tissue?

    <p>Ectopic thyroid</p> Signup and view all the answers

    What distinguishes benign thyroid nodules from malignant ones?

    <p>Benign nodules usually have less complex structures.</p> Signup and view all the answers

    What is the implication of finding a thyroid nodule during a carotid ultrasound?

    <p>It is usually a benign finding.</p> Signup and view all the answers

    Which type of thyroid carcinoma is more common than others?

    <p>Papillary carcinoma</p> Signup and view all the answers

    What is the typical demographic trend in cases of congenital hypothyroidism?

    <p>More common in females</p> Signup and view all the answers

    Which procedure may be required to confirm the absence or abnormal location of thyroid tissue?

    <p>Nuclear medicine scans</p> Signup and view all the answers

    What describes the echotexture associated with Hashimoto's Thyroiditis?

    <p>Hypoechoic and heterogeneous with fibrous septations</p> Signup and view all the answers

    Which clinical symptom is NOT typically associated with Grave's Disease?

    <p>Weight gain</p> Signup and view all the answers

    What is the main characteristic of the thyroid during Color Doppler examination in Grave's Disease?

    <p>Hypervascular with prominent intraparenchymal blood vessels</p> Signup and view all the answers

    What is a common cause of Diffuse Thyroid Hyperplasia?

    <p>Iodine deficiency</p> Signup and view all the answers

    How can micronodulation in the thyroid gland be characterized?

    <p>Multiple tiny nodules typically less than 6mm</p> Signup and view all the answers

    Which of the following is true regarding the enlarged gland found in Grave's Disease?

    <p>Shows decreased echogenicity and heterogeneous echotexture</p> Signup and view all the answers

    What demographic is most commonly affected by Diffuse Thyroid Hyperplasia?

    <p>Females over 50</p> Signup and view all the answers

    What diagnostic procedure is used for assessing nodules in heterogeneous echotexture?

    <p>Fine Needle Aspiration (FNA)</p> Signup and view all the answers

    What is the sonographic appearance of Anaplastic Carcinoma?

    <p>Hypoechoic, rapidly enlarging mass</p> Signup and view all the answers

    Which of the following statements about Thyroid Lymphoma is true?

    <p>The prognosis depends on the stage at diagnosis</p> Signup and view all the answers

    What is the most common type of gland inflammation known?

    <p>Hashimoto’s Thyroiditis</p> Signup and view all the answers

    How does Thyroid Metastases typically present sonographically?

    <p>Solitary, solid nodule with hypoechogenicity</p> Signup and view all the answers

    What is a common symptom associated with Thyroiditis?

    <p>Feeling of fullness in the throat</p> Signup and view all the answers

    Which primary cancers are most commonly associated with Thyroid Metastases?

    <p>Melanoma, breast, and renal cell carcinoma</p> Signup and view all the answers

    What characteristic feature is seen with acute suppurative thyroiditis sonographically?

    <p>Hypoechoic mass with potential abscess formation</p> Signup and view all the answers

    Which of these facors is associated with Hashimoto's Thyroiditis?

    <p>Autoimmune diseases with antibodies to thyroglobulin</p> Signup and view all the answers

    What defines the growth pattern of Diffuse Thyroid Disease?

    <p>Diffuse gland enlargement with possible focal nodules</p> Signup and view all the answers

    What is the typical 5-year mortality rate for Anaplastic Carcinoma?

    <p>Greater than 95%</p> Signup and view all the answers

    What is a common sonographic appearance of a multinodular goiter?

    <p>Multiple indistinguishable nodules throughout the gland</p> Signup and view all the answers

    Where are ectopic parathyroid glands most likely to be found?

    <p>In the posterior or posterolateral to the trachea</p> Signup and view all the answers

    Which of the following describes parathyroid adenoma?

    <p>Benign neoplasm usually single</p> Signup and view all the answers

    How does parathyroid carcinoma differ from parathyroid adenoma?

    <p>Parathyroid carcinoma is a malignant neoplasm</p> Signup and view all the answers

    What is a key characteristic of parathyroid hyperplasia?

    <p>Benign overgrowth of parathyroid tissue</p> Signup and view all the answers

    Which location is considered uncommon for ectopic parathyroid glands?

    <p>Superior mediastinum</p> Signup and view all the answers

    What differentiates the visualization of ectopic parathyroid glands anteriorly to the trachea from posteriorly?

    <p>Only a portion may be visualized due to tracheal shadowing</p> Signup and view all the answers

    Which feature is most associated with the difficulty in diagnosing ectopic parathyroid glands?

    <p>They can be misdiagnosed as lymph nodes</p> Signup and view all the answers

    What is the most common sonographic appearance of a Thyroid Hyperplasia nodule?

    <p>Isoechoic with hypoechoic halo</p> Signup and view all the answers

    Which of the following statements about Benign Follicular Adenomas is accurate?

    <p>They compress adjacent tissues as they grow.</p> Signup and view all the answers

    What distinguishes Follicular Carcinoma from Follicular Adenoma on sonographic evaluation?

    <p>Thick and irregular margins and halo</p> Signup and view all the answers

    What is the most common type of thyroid carcinoma?

    <p>Papillary carcinoma</p> Signup and view all the answers

    What is the primary route of metastasis for Follicular Carcinoma?

    <p>Hematogenous spread</p> Signup and view all the answers

    Which thyroid carcinoma is classified as the most aggressive?

    <p>Anaplastic carcinoma</p> Signup and view all the answers

    What is often seen in the sonographic appearance of Papillary Carcinoma?

    <p>Coarse calcifications</p> Signup and view all the answers

    What characteristic distinguishes Medullary Carcinoma from other thyroid carcinomas?

    <p>It secretes calcitonin.</p> Signup and view all the answers

    What is the significance of the thin septations seen in Thyroid Hyperplasia nodules?

    <p>A sign of benign cystic degeneration</p> Signup and view all the answers

    Which type of thyroid carcinoma has a higher likelihood of causing cervical lymphadenopathy?

    <p>Papillary carcinoma</p> Signup and view all the answers

    What is a common appearance of cystic degeneration in Thyroid Hyperplasia?

    <p>Honey-comb appearance</p> Signup and view all the answers

    What is the typical prognosis of Papillary Carcinoma?

    <p>Overall good with a 20-year MR of 4-8%</p> Signup and view all the answers

    Why is Biopsy/FNA often considered useless for diagnosing Follicular Adenoma?

    <p>It cannot differentiate between adenoma and carcinoma.</p> Signup and view all the answers

    Study Notes

    The Neck - Thyroid and Non-Thyroid Pathology and Interventions

    • Topic is related to the neck, specifically thyroid and non-thyroid conditions and interventions.

    Thyroid Gland Pathology

    • Congenital Abnormalities:

      • Agenesis/Aplasia: Absence of the thyroid gland.
      • Ectopic thyroid: Thyroid tissue in an abnormal location.
      • Hypoplasia: Underdeveloped thyroid gland.
      • Congenital Hypothyroidism: Lack of thyroid hormone production.
      • Congenital cysts: Inherited cysts in the thyroid.
    • Nodular Thyroid Disease:

      • Benign and malignant nodules.
      • Hyperplasia, adenomas, carcinomas, metastases (spread to other tissues)
    • Diffuse Thyroid Disease:

      • Thyroiditis: Inflammation of the thyroid gland.
      • Grave's disease: Autoimmune disorder causing hyperthyroidism.
      • Multinodular goitre: Enlarged thyroid gland with multiple nodules.

    Thyroid Lab/Imaging Tests

    • Thyroid:
      • T3 and T4 hormone levels: Increased (hyperthyroidism) or decreased (hypothyroidism)
      • TSH (thyroid-stimulating hormone): Indicates thyroid or pituitary dysfunction
    • Blood work: Measures thyroid and other hormones, response to treatment.
    • Thyroid Scan: Diagnoses overactive or underactive thyroid gland; assesses risk of malignancy.
    • Nuclear Medicine (Scintigraphy): Assesses thyroid function by measuring uptake of radioactive iodine by thyroid tissue.

    Congenital Abnormalities (Specific)

    • Thyroid Agenesis/Aplasia: Complete absent thyroid gland or hemi-agenesis (one lobe missing).
    • Ectopic Thyroid: Abnormal tissue location, lingual or suprahyoid.
    • Thyroid Hypoplasia: Partial or complete underdeveloped thyroid gland.
    • Congenital Hypothyroidism: Variable severity and more common in females.
    • Congenital Cysts: Rare, often part of larger thyroid masses.

    Nodular Thyroid Disease (details)

    • Can present with a palpable abnormality or discovered incidentally.
    • Happens in 4%-7% of adults, more common in females.
    • Etiologies:
      • Benign: Focal thyroid hyperplasia, benign follicular adenomas.
      • Malignant: Thyroid carcinoma (papillary, follicular, medullary, anaplastic, lymphoma, metastases).

    Benign vs Malignant Thyroid Nodules

    • Management is controversial, as thyroid cancer is rare compared to common nodules.
    • "Dominant nodule" is frequently aspirated for assessment, but this value is not indicative.
    • Presence of multiple abnormal findings increases malignancy risk.

    Sonographic Appearance (Tables)

    • Detailed table describing malignant and benign thyroid nodules' sonographic characteristics (internal contents, echogenicity, shape, margins, calcification pattern, peripheral halo, blood flow, and elastography patterns)

    ACR TI-RADS

    • System to categorize thyroid nodules on ultrasound findings (composition, echogenicity, shape, margins, and echogenic foci) and provide a risk assessment. This categorizes results from 1-7.

    Internal Contents/Composition, Echogenicity, Shape, and Margins

    • Explanations and visual examples of scores 0, 1, 2, 3 for the four parameters in characterizing nodules on ultrasound.

    Blood Flow Pattern

    • Blood flow doesn't affect scoring using TIRADS criteria.

    Thyroid Imaging Reporting and Data System (TIRADS)

    • Six categories for classifying thyroid nodules based on ultrasound findings (1-Normal, 2-Benign, 3-Probably Benign, 4-Suspicious, 5-Probably Malignant, 6-Biopsy-Proven Malignant).

    Focal Thyroid Hyperplasia

    • AKA thyroid nodule, benign, focal overgrowth of thyroid tissue, most common cause of nodular disease (80%), females > males, peak age 35-50. -May be hereditary or caused by iodine deficiency.
    • Lab tests can show decreased, increased or normal lab test function.

    Thyroid Hyperplasia (Nodule)

    • Sonographic Appearance: Usually single, isoechoic(most common), may be hyperechoic if large, common cystic degeneration (simple cyst appearance, not true cysts), anechoic fluid = colloid (colloic cysts), Echogenic fluid = hemorrhage, honeycomb appearance.
      • May see hypoechoic halo, peri-nodular vascularity, thin septations, echogenic foci with comet-tail, calcifications (coarse or egg-shell), solid papillary projections, and internal vascularity

    Papillary Carcinoma

    • Most common thyroid carcinoma (75-90%), 2 peaks (30s and 70s), least aggressive, spread is lymphatic, metastases to cervical lymph nodes (most common) or mediastinum and lung (less commonly).
      • Sonographic Appearance: Solid hypoechoic mass, microcalcifications, tiny punctate echogenic foci, with or without shadowing, hypervascularity (90%).

    Follicular Carcinoma

    • 2nd most common,
    • 5-15% of thyroid carcinomas, two types (minimally and widely-invasive).
    • Spread is hematogenous, metastases to: bone, lung, brain, liver.
    • Sonographic Appearance: solid mass, single or multiple, variable echogenicity, hypoechoic, hyperechoic or isoechoic, peripheral hypoechoic halo, thick and irregular compression of adjacent tissue, peripheral vascularity, possible internal vascularity (spoke wheel pattern).

    Follicular Adenoma vs Follicular Carcinoma

    • Sonographic appearance is similar, especially for small sizes.
    • Diagnoses require histology.

    Medullary Carcinoma

    • 5% of thyroid carcinomas, derived from parafollicular (C) cells, secretes calcitonin.
    • More aggressive than papillary and follicular. Metastases are to cervical lymph nodes.
    • Sonographic appearance: solid, hypoechoic mass, coarse calcifications (can have shadowing), cervical lymphadenopathy (also can have calcifications), lesions can be all over the body.

    Anaplastic Carcinoma

    • Least common, 2% of thyroid cancers. Elderly population, associated with papillary or follicular carcinoma.
    • Most aggressive type, 5 year survival rate >95%. Spread via local invasion into muscles and vessels of the neck.
    • Sonographic Appearance: Hypoechoic, rapidly enlarging, encases or invades vessels and muscles; extra imaging (CT or MRI) may be needed because of the large size.

    Thyroid Lymphoma

    • Lymphoma affects any organ, usually non-Hodgkin's type.
    • Prognosis and aggressiveness vary with stage of diagnosis.
    • Frequently fast-growing, causing difficulty breathing and swallowing.
    • Sonographic Appearance: Extremely hypoechoic, lobulated mass, may have cystic necrosis of the lesion, encasing adjacent structures, and hypovascularity.

    Thyroid Metastases

    • Malignant spread from another primary tumor to the thyroid. It's rare.
    • Commonly occurs during later stages of the primary disease.
    • Primary sites: melanoma, breast, and renal cell carcinoma (RCC).
    • Sonographic Appearance: Solitary, solid nodule, well-circumscribed, hypoechoic, no calcifications common.

    Diffuse Thyroid Disease (overview)

    • Thyroiditis, Grave's disease, multinodular goiter. Characterized by diffuse gland enlargement, may be symmetric or asymmetric, with or without focal nodules. The isthmus thickness is measured by ultrasound and should be greater than 6 mm.

    Thyroiditis (Overview)

    • Inflammation or infection of the thyroid gland.
    • Symptoms: Pain, fever, enlarged and edematous gland, feeling of fullness in the throat and tenderness.
    • Various types: Acute suppurative, de Quervain's, Hashimoto's. Inflammatory patterns may include specific findings such as abscesses and/or inflammatory nodes.

    Thyroiditis (Specific types)

    • Acute Suppurative Thyroiditis: Rare bacterial infection, commonly in the pediatric population, with inflammation patterns of enlarged gland, decreased echogenicity, and increased vascularity (including possibly abscess formation).

    • de Quervain's Thyroiditis: Viral infection, with ultrasound patterns similar to other thyroiditis findings.

    • Hashimoto's Thyroiditis: Most common, often painless but characterized by diffuse gland enlargement, more common in females than males. Associated with hypothyroidism (↓T3 & T4). May be caused by autoimmune diseases, antibodies, and pregnancy. Ultrasound may show enlarged gland that progressively shrinks to a small, atrophic gland, decreased echogenicity, heterogeneity and micronodulation(multiple, tiny nodules <6 mm).

    Grave's Disease

    • Common cause of diffuse enlargement of the gland, associated with hyperthyroidism (↑T3 & T4), with various clinical and measurable indicators.
    • Can be asymptomatic.
    • Enlarged gland, heterogeneous echotexture, reduced echogenicity, with prominent intraparenchymal (internal to the gland) blood vessels, hypervascularity easily apparent on color doppler.

    Diffuse Thyroid Hyperplasia (Multinodular Goiter)

    • Diffuse overgrowth of the thyroid, most common in thyroid abnormalities, occurring after age 50 frequently in females.
    • Could be inherited or related to iodine deficiency.
      • Enlarged thyroid, heterogeneous, composed of multiple indistinguishable nodules throughout the gland, which may extend into the mediastinum and have an uneven appearance (heterogeneous).

    Parathyroid Gland Pathology

    • Ectopic parathyroid glands.
    • Parathyroid masses.
    • Hyperparathyroidism.

    Parathyroid Masses (characteristics)

    • Parathyroid adenoma: Benign neoplasm, typically single.
    • Parathyroid hyperplasia: Benign overgrowth, usually multiple. Commonly associated with MEN I syndrome, a hereditary disorder.
    • Parathyroid carcinoma: Rare malignant neoplasm.
    • Sonographic Appearance: Most are solid masses, posterior to thyroid, can be ectopic, size from 1.5cm to 5cm, homogeneous hypoechoic appearance, and hypervascular on Color Doppler (when present)

    Other Neck Pathology

    • Branchial cleft cyst: Remnants of embryonic branchial cleft, typically to the side of the thyroid, commonly found in young children, easily seen on ultrasound if present.
      • Sonographic Appearance: Can be cystic (with possible complexities such as septations and fluid levels) and can be infected (with debris).
    • Thyroglossal duct cyst: Remnants of embryologic thyroglossal duct, midline, anterosuperior to thyroid and has variable appearance
      • Sonographic Appearance: Can be cystic (with possible complexities including septations & fluid-debris levels).
      • Symptoms may include pain and fever.
    • Lymphadenopathy: Enlarged lymph nodes. Benign and malignant types differ in ultrasound appearance, with benign nodes typically being oval, 1-2 cm, hypoechoic with fatty, echogenic central hilum. Malignant nodes are smaller, round to oval, have a long/transverse ratio < 2, and more eccentricities in echogenicity, lacking central hilum, and no vascularity

    Interventions

    • Fine Needle Aspiration/Biopsy: Often used for indeterminate neck masses; particularly nodules >1.5 cm.
      • Results are classified as 4 categories (negative, positive for malignancy, suggestive of malignancy, and nondiagnostic/inadequate sampling.)
    • Thyroidectomy: Surgical procedure for removal of all or part of the thyroid gland. Post-operative follow-up is a common protocol and may include ultrasound.

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    Description

    Test your knowledge of thyroid pathologies and conditions with this engaging quiz. Questions cover congenital hypothyroidism, thyroid nodules, lab tests, and imaging characteristics. Challenge yourself to see how well you understand these important topics in endocrinology.

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