by mtoom


keywords:
Bookmark and Share



Front Back
What effect do ANP and BNP have on aldosterone?
  • ANP (atria) and BNP (ventricules) released from heart due to fluid overload
  • Directly inhibit renin and aldosterone
What 3 factors control secretion of aldosterone from adrenal cortex?
  • RAAS
  • Potassium (High K+ stimulates)
  • ACTH
  • Cortisol is highest at what time of day?
  • What is the cortisol pattern called? 
  • Highest in morning (goes down throughout the day)
  • Called diurnal
When is DHEA replacement warranted?
Women with primary adrenal failure
What hormone is released from adrenal cortex at same levels as cortisol?
DHEA
When is the only time to do surgical thyroidectomy?
Graves patients with opthalmological problems
What antibody is seen in Hashimoto Thyroiditis?
  • Anti-TPO
What is used to image the pituitary? (1)
MR
What is used to image the thyroid? (1)
U/S
What is used for thyroid function testing? (2)
  • Nuclear (I123, I131, TcO4)
  • PET/FDG
When is CT used for thyroid? (1)
Follow up of Cancer patients
Most thyroid nodules, whether benign or malginant, are HOT or COLD?
Cold
When is PET/FDG used for thyroid?

When patient has both:
  • Elevated thyroglobulin
  • Negative radioactive iodine uptake scan
What is used to image the parathyroid? (1)
U/S
What is used for parathyroid function? (1)
Nuclear medicine
What is used to image adrenals? (2)
  • CT
  • MRI 
What is used to evaluate adrenal function? (1)
  • Nuclear medicine (MIBG)
What is the 10% rule of pheochromocytoma?
  • 10% bilateral
  • 10% malignant
  • 10% ectopic (paraganglioma)
How to evaluate structure of Pancreatic Islets? (2)
  • CT
  • US
How to evaluate function of Pancreatic Islets? (1)
  • Nuclear medicine
    (111-ocreotide) 
When is thyroglobulin found in serum?
In normal and pathological settings
  • After thyroidectomy to get rid of cancer, it can be used to detect if there is still any thyroid tissue (sort of like a tumor marker) 
Most common cause of hypothyroidism in a middle-aged woman?
Hashimoto's thyroiditis
Can Graves disease manifest with hypothyroid phase? If so, why?
Yes, because of thyroid inhibiting antibodies
What is the major source of free thyroid hormone in the blood?
Transthyretin
What is the Wolff-Chaikoff effect?
Iodine can downregulate thyroid hormone levels:

Thyroid gland stops producing temporarily in the setting of extreme iodide excess.
  • Therapuetic approach to thyroid storm 
Thyroglossal duct cyst
  • Definition
  • Presentation
  • Pathology
  • Treatment
  • Risks
  • Definition: Cystic dilatation of persistent thyroglossal duct
  • Presentation: Most common midline neck mass (usually painless)
  • Pathology: Lined by respiratory or squamous epithelium, can become infected
  • Treatment: Surgery
  • Risks: 1-2% of papillary carcinoma
  • What types of thyroiditis are painful?
  • What types are not painful? 
Painful
  • Acute
  • Subacute (de Quervains)
Not painful
  • Hashimoto's (Chronic lymphocytic) 
Acute Suppurative Thyroiditis
  • Definition
  • Incidence
  • Etiology
  • Clinical
  • Labs
  • Pathology
  • Treatment
  • Definition: Acute inflammation of the thyroid gland secondary to infection
  • Incidence: Rare
  • Etiology: Usually bacterial
  • Clinical: Ill, high fever, tachycardia, neck pain, dysphagia, dysphonia
  • Labs: High ESR, leukocytosis
  • Pathology: PMNs infiltrate and destroy thyroid
  • Treatment: Antibiotics, drainage
Subacute (Granulomatous) Thyroiditis = DeQuervain's
  • Definition
  • Incidence
  • Clinical
  • Etiology
  • Pathogenesis
  • Labs
  • Pathology
  • Treatment
  • Definition: Granulomatous inflammation of unknown etiology
  • Incidence: 5% of patients with clinical thyroid disease
  • Clinical:
    -Prodrome (myalgias, fatigue, fever, pharyingitis)
    -Fever, neck pain, swelling
    -50% hyperthyroidism
    -Hypothyroidism for weeks/months
    -Recovery in 95%
  • Etiology: Presumed to be a viral infection
  • Pathogenesis: Destruction of thyroid follicles releases thyroglobulin, bound T4/T3 causes transiet hyperthyroidism; later decreased thyroid function due to destroyed follicles
  • Labs: High ESR, High T4 low TSH, then low T4 high TSH
  • Pathology: Granulomatous inflammation, histiocytes and giant cells, damaged follicles, patchy infiltration of chronic inflammatory cells
  • Treatment: NSAID, steroids (short course if severe), beta-blockers for thyrotoxicosis, T4 replacement (rare)
What is the most common cause of thyroid pain?
Subacute Thyroiditis = Granulomatous Thyroiditis = DeQuervain's Thyroiditis
Hashimoto thyroiditis
  • Definition
  • Clinical
  • Labs
  • Pathology
  • Treatment
  • Complications
  • Definition: Chronic lymphocytic inflammation, often leads to permanent hypothyroidism
  • Clinical: Goiter, symmetric enlargement, painless
  • Labs: Anti-TPO (90%), T4/TSH (may be normal at diagnosis)
  • Pathology:
    -Diffuse chronic inflammation (lymphocytes, plasma cells)
    -Oncocytic change in follifcular epithelial cells
    -Follicular disruption/destruction
  • Etiology: Autoimmune antibodies against TPO
  • Treatment: Thyroxine suppression (increase size), surgery, thyroxine replacement
  • Complications: 67x increase in NH lymphoma
What is the most common form of thyroiditis?
Hashimoto
Important symptoms of Graves disease (4)
  • Diffuse uniformly enlarged goiter
  • Toxic (hyperthyroid)
  • Opthalmopathic (eyes)
  • Dermatopathic (skin)
Graves disease
  • Incidence
  • Clinical
  • Pathology
  • Pathogenesis
  • Treatment
  • Incidence: Very common, familial
  • Clinical: hot, tremor, tachycardia, exopthalmos, lid retraction, lid lag, pretibial myxedema
  • Pathology:
    -orbit: inflammatory cells
    -skin: mucin deposited in dermal CT
    -gland: diffuse symmetric enlargement
  • Pathogenesis: Thyroid stimulating antibodies to TSH receptor with agonist action
  • Treatment: Suppression (propylthiouracil), radioactive iodine or surgery, replace with T4
Nodular goiter
  • Definition
  • Incidence
  • Definition: Enlarged gland with multiple nodules and normal function
  • Incidence: Most common thyroid disease worldwide, high prevalence with iodine deficiency
  • Clinical: Painless neck swelling, big neck mass
  • Treatment: Surgery
Name 1 benign thyroid neoplasm
Follicular adneoma
Name 4 malignant thyroid neoplasms
  • Follicular carcinoma (10%)
  • Papillary carcinoma (75-85%)
  • Undifferentiated (Less than 5%)
  • Medullary carcinoma (5%)
Follicular adenoma
  • Benign/malignant**
  • Definition
  • Incidence
  • Pathology**
  • Pathogenesis
  • Treatment
  • Benign/Malignant: Benign
  • Definition: Benign neoplasm composed of cells showing follicular epithelial differentiation; rarely hyperfunction
  • Incidence: Common
  • Pathology: Solitary, circumscribed, encapsulated, variable size, uniform cells, solid, compresses parenchyma, different epithelium than normal
  • Pathogenesis: Mutations in signaling cause chronic stimulation of cAMP pathway
  • Treatment: Hemi-thyroidectomy
Follicular carcinoma
  • Benign/malignant
  • Definition
  • Incidence
  • Etiology/pathogenesis
  • Pathology
  • Treatment/Prognosis
  • Benign/malignant: Malignant
  • Definition: Malignant neoplasm composed of cells showing follicular epithelial cell differentiation
  • Incidence: Uncommon
  • Etiology/pathogenesis: Radiation exposure, increase in regions with endemic goiter, ras oncogene
  • Pathology:
    -Adenoma
    -Well-circumscribed, thicker capsule
    -Invasion through capsule
    -Invasion into blood vessels in the capsule or outside tumour
  • Treatment/Prognosis: Total thyroidectomy, radioactive iodine; excellent prognosis if minimal invasion
What is the most common thyroid carcinoma?
Papillary thyroid carcinoma
Papillary thyroid carcinoma
  • Risk factors
  • Gross pathology
  • Micro pathology
  • Genetics
  • Treatment
  • Prognosis
  • Risk factors: Radiation, FAP
  • Gross pathology:
    -non-encapsulated
    -poorly circumscribed
    -invasive
  • Micro pathology:
    -Defined by nuclear features
    -Optically clear nuclei
    -Grooves and nuclear inclusions
    -Psammoma bodies are present
  • Genetics: RET/PTC translocation, BRAF mutations
  • Treatment: Surgery, radioactive iodine
  • Prognosis: Excellent
What is a key feature of benign vs malignant thyroid masses?
Malignant have abnormal nuclear features
Medullary carcinoma
  • Definition
  • Incidence
  • Etiology
  • Signs/symptoms
  • Pathology
  • Treatment
  • Prognosis
  • Definition: Malignant thyroid tumor showing C-cell differentiation
  • Incidence: Rare
  • Etiology: Unknown, RET mutations?
  • Signs/symptoms: Asymptomatic mass, serum calcitonin often high
  • Pathology: Polygonal, spindle cells
  • Treatment: Surgery
  • Prognosis: Bad for MEN IIB
Anaplastic carcinoma
  • Definition
  • Pathology
  • Prognosis
  • Definition: Highly malignant thyroid carcinoma with no differentiation along known cell lines
  • Pathology: High grade spindle cell
  • Prognosis: 5 year survival less than 10%
x of y cards