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Endocrine Pathology Lab. April 3, 2014. Case 1: Q1: Please describe the following gross and microscopic thyroid. Case 2. CHIEF COMPLAINT : “I have a lump in my neck”

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Case 1 q1 please describe the following gross and microscopic thyroid
Case 1: Q1: Please describe the following gross and microscopic thyroid


Case 2
Case 2

CHIEF COMPLAINT: “I have a lump in my neck”

HISTORY: The patient is a 42-year-old female who noticed a painless lump in her neck about a month ago. It has not seemed to increase or decrease in size.

She has no chronic medical problems and has had no surgeries.

She takes no medications.

Her father and mother are alive and well. She is an only child.

She has no diarrhea or constipation, no heat or cold intolerance, stable weight, no change in skin or hair texture.


PHYSICAL EXAMINATION:

A painless 3cm mass is palpated in the left neck. The mass moves when the patient swallows and seems contiguous with the thyroid gland. The remainder of the thyroid gland is normal. There is no cervical or supraclavicular lymphadenopathy. The remainder of the physical exam is unremarkable.



Q2 based on the given data is the patient clinically euthyroid hyperthyroid or hypothyroid
Q2: Based on the given data, is the patient clinically euthyroid, hyperthyroid, or hypothyroid?


Lab data
Lab Data euthyroid, hyperthyroid, or hypothyroid?

  • TSH 1.2 (0.4-4.4 uu/mL)


Iodine uptake scan
Iodine uptake scan euthyroid, hyperthyroid, or hypothyroid?

Most benign and virtually all malignant thyroid

nodules concentrate iodine radioisotopes less

avidly than adjacent normal thyroid tissue

These nodules appear “cold” and generally

require further evaluation by FNA

Cold nodule left upper thyroid gland

Remainder of thyroid uptake is normal.


Fine needle aspiration
Fine Needle Aspiration euthyroid, hyperthyroid, or hypothyroid?

  • “Follicular Neoplasm”



Q5 describe gross findings
Q5: Describe gross findings distinguishing features


Q6 describe the histopathology
Q6: Describe the histopathology distinguishing features


Q7 compare and contrast the histopathology seen here
Q7: Compare and contrast the histopathology seen here distinguishing features

Normal Thyroid

Follicular Adenoma of the thyroid


Q8 what is your diagnosis
Q8: What is your diagnosis? distinguishing features




Case 3
Case 3 distinguishing features

CHIEF COMPLAINT: Routine physical.

HISTORY: 55-year-old woman presents for an annual physical exam. She feels well and has no concerns except that perhaps her cholesterol might be high due to dietary indiscretion.

She has no chronic medical problems and has had no surgeries.

She takes no medications.

She is adopted and does not know of her family history.


PHYSICAL EXAMINATION distinguishing features:

A painless 2.5 cm nodule is palpated in the left thyroid gland. There is an enlarged, nontender 2cm left cervical lymph node. Exam is otherwise unremarkable.



Diagnostic work up
Diagnostic work-up diagnosis?

  • Normal TSH

  • “Cold” thyroid nodule on iodine uptake scan

  • FNA

  • Results of above lead to Thyroidectomy




What is your diagnosis
What is your diagnosis? diagnosis?

  • Papillary carcinoma

  • The most common thyroid carcinoma

  • About half of cases will have metastasis to cervical lymph nodes at the time of a diagnosis



Other genes
Other genes condition?

  • BRAF

    • Encodes a signaling intermediary in MAP kinase pathway

    • 33-50% papillary thyroid cancers have activating mutation in BRAF gene



Case 4
Case 4 carcinoma?

CHIEF COMPLAINT: “I’ve been feeling tired and cold all the time”

HISTORY: 60-year-old previously healthy woman presents with fatigue and cold intolerance. She has had about 10 pound weight gain over the past 6 months which she attributes to inactivity. She is being treated for hypertriglyceridema with gemfibrozil. She started taking laxatives about 3 months ago for constipation. She does not smoke or drink alcohol.


PHYSICAL EXAMINATION carcinoma?:

Alert and oriented female

Pulse 61, BP 150/90

Thyroid gland is diffusely enlarged. No nodules are palpated. No cervical LAD is present.

Lung, heart, and abdominal exams are unremarkable.



Diagnostic evaluation
Diagnostic evaluation diagnosis?

TSH 21.2 (0.4-4.4 uu/mL)

Free T4 0.4 (0.8-1.7 ng/dL)


Q2 etiologies of primary hypothyroidism
Q2: Etiologies of diagnosis?Primary Hypothyroidism?







Case 5
Case 5 diagnosis?

HISTORY 55-year-old female presents for physical exam. She has not seen a physician in many years. She feels well except for some mild dyspnea on exertion. She has no chest pain, no leg edema, no weight loss or weight gain, no heat or cold intolerance, no palpitations, no difficulty swallowing. She has no known chronic medical problems. She had an appendectomy at age 15. She takes no medications.


PHYSICAL EXAMINATION diagnosis?:

Well-developed, pulse 72, BP 112/64. Both lobes of the thyroid gland are enlarged. Several small, bilateral nontender thyroid nodules are palpated. Exam is otherwise unremarkable.




Thyroid Ultrasound TSH to be?






Goiter Causing TSH to be?

Tracheal

compression


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