Be this as it may, lots of kids have goiters because of lymphocyticinfiltration, some will be euthyroid, some will behypothyroid, and you'll make these goiters shrink with thyroid hormonetherapy (J.
before you give that patient in myxedema coma a nice booster of thyroid hormone, first administer glucocorticoid so as not to cause death from acute adrenal insufficiency!
If you biopsy it (and you usually don't), patients with Hashimoto's disease will exhibit (1) lots and lots of lymphocytes in the thyroid gland; (2) germinal centers; (3) plasma cells; (4) Hürthle cells (i.e., cells packed with mitochondria, also called "oncocytes"; they probably don't make thyroid hormone).
151: 178, 2007) Iodine deficiencyEpidemic goiterKU CollectionBIRTH DEFECTS Thyroid MalformationsFrom ChileIn Spanish THYROGLOSSAL DUCT CYSTS are bits of the old thyroglossal duct.
Jod-Basedow (very important in the iodine-poor nations, not so much in the US) Well-differentiated thyroid cancer (occasional cases, uncommon) DeQuervain's with rapid release of thyroglobulin (uncommon) * "Silent thyroiditis" -- a few weeks of elevated thyroid, without any physical findings or known histopathology (wastebasket, but real; think of drug allergy)Post-partum (mild, if you examine the gland, you'll see lymphocytes)Amiodarone (at least 5 known effects on cells / enzymes here -- look for foamy macrophages full of this oily iodine-rich medicine in the follicles)Pituitary TSH-oma (very rare) Choriocarcinoma / hydatidiform mole (recall that TSH is chemically similar to hCG) Excess TRH (tertiary hyperthyroidism, very rare) Struma ovarii (thyroid / thyroid cancer in an ovarian teratoma; rare -- and amazingly, it's impossible to tell from the histology how it will behave Arch.
also Brussels sprouts, turnips, cauliflower, and the thiocyanate-rich central African cassava that also causes CNS damage; lithium and cobalt can also be also goitrogens) Hashimoto's autoimmune thyroiditis or severe chronic lymphocytic thyroiditis DeQuervain's (the disease is common, but hypothyroidism as a resultis rare and probably transitory) * Autoimmune type II (some antibodies block but do not stimulate TSH receptors) Amiodarone toxicity, as below -- another fact worth remembering about this trickymedicine is that it inhibits entry of thyroid hormones into the peripheral tissuesSecondary hypothyroidism (i.e., disease of the adenohypophysis; this is much lesscommon than primary hypothyroidism; thereare also mutations of receptors that interfere with TSH production, and mutationsof TSH itself J.
92: 3158, 2007) A problem with thyroxine synthesis or release -- the most common causeis peroxidase deficiency Non-functioning thyroid hormone receptors (J.
* "Subclinical hyperthyroidism", with low hTSH but "normal range" thyroidhormone levels, seems to put a lot of older folks at risk for atrial fibrillationand overall mortality.
If you don't remember its histology and physiology -- follicles full of colloid, iodine traps, microvilli, parafollicular C-cells, thyroxine=T4, iodotyrosine precursor compounds, triiodothyronine=T3, calcitonin (remember it'sfrom the parafollicular cells that aremostly in the upper lobes), synthesis and endocytosis of thyroglobulin,TRH, TSH=hTSH=thyrotropin, etc.
The rumor that about 25% of peoplewith major depression and normal labs respond dramatically to a bit of thyroidsupplementation suggests to me that it's best to "treat the protoplasm, not the numbers." GRAVES'S DISEASE (NEJM 358: 2704, 2008) Graves's Graves'sGraves'sWebPath PhotoGraves'sWebPath Photo This is a common problem caused by autoantibodies directed against the hTSH receptor.
of TokushimaGoiterFrom ChileIn SpanishEndocrineBrown Digital PathologySome nice casesEndocrineUtah cases for path studentsJuliana Szakacs MDEndocrineIowa Virtual MicroscopyHave fun Thyroid ExhibitVirtual Pathology MuseumUniversity of Connecticut EndocrinePhotos, explanations, and quizIndiana U.
Graves's with scalloping If the patient has been pre-treated with a goitrogen, you'll less colloid and more papillary formations (why?) If the patient has been treated with a huge dose of iodine to suppress thyroid hormone formation, you'll see a colloid goiter (why?) Today, most patients prefer to take a drink of I131, though they know this will eventually make them hypothyroid.
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* Let us worry about "dyshormonogenetic goiter" a genetic syndrome with difficulty synthesizingthyroid hormones, deafness,hypothyroidism, an enormous thyroid composed mostly of fibrous tissue, very pleomorphic nuclei,and no cancer risk.