Endocrine Pathology

A. Thyroid Gland

1. Multinodular goiter (nontoxic goiter)

a. Presentation i. Females > males ii. Frequendy asymptomatic iii. Typically euthyroid iv. Goiter v. Plummer syndrome: development of hyperthyroidism (toxic multinodular goiter) late in the course b. Gross: enlarged thyroid gland with multiple colloid nodules c. Microscopic i. Nodules of varying sizes composed of colloid follicles Li. Calcification, hemorrhage, cystic degeneration, and fibrosis d. Lab: normal T4, T3, and TSH

B. Hyperthyroidism

1. General features of hyperthyroidism a. Clinical features i. Tachycardia and palpitations ii. Nervousness and diaphoresis iii. Heat intolerance iv. Weakness and tremors v. Diarrhea vi. Weight loss despite a good appetite b. Lab i. Elevated free T4

ii. 1° hyperthyroidism: decreased TSH

iii. 2° and 3" hyperthyroidism: elevated TSH

2. Graves disease a. Definition: autoimmune disease characterized by production of IgG autoantibodies to the TSH receptor b. Clinical features i. Females > males; age 20-40

ii. Hyperthyroidism iii. Diffuse goiter

Note

Long-acting thyroid stimulator (LATS): original name for the autoantibodies of Graves disease

Thyroid-stimulating immunoglobulin (TSI): current name for the autoantibodies of Graves disease

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