What is the most common type of thyroid ca
- papillary thyroid ca
- diagnosis via FNA:
- characteristic cell morphology:
- large cells with nuclei containing finely dispersed chromatin with a ground-glas appearance (Orphan Annie eye)
- characteristic cell morphology:
What are the FOUR (4) main types of thyroid ca
- papillay
- follicular
- medullary
- anaplastic
Papillary (1/4) Buzzwords
- major RF: ionizing radiation in childhood
- Orphan Annie eye
- psammoma bodies
- excellent prognosis
Follicular (2/4) Buzzwords
- invasion through the thyroid capsule
- solitary cold nodule-spread to different lobes and distort thyroid tissue
- hematogneous mets
- mets of areas with high blood flow: lungs, liver, bones
Medullary (3/4) Buzzwords
- parafollicular C cells
- neuroendocrine secretes Calcitonin
- INC renal calcium
- modify bon resorption
- DEC GI absorption
- inactive at nml physiologic levels
- high levels: hypocalcemia
- deposits within tumor as AMYLOID
- familial: RET oncogene (c10)
- MEN2A, MEN2B
- prophylactic thyroidectomy
Anaplastic (4/4) Buzzwords
- undifferentiated, aggressive
- pleomorphic cells, including irregular giant cells and biphasic spindle cells
- elderly
- POOR prognosis
Insuline overall effects
- INC peripheral glucose uptake
- inhibits lipolysis and ketoacid formation
- suppresses glucagon release
Insulin target organs (LIVER)
- liver
- INC glucose uptake
- INC glycogen synthesis
- DEC glycogenolysis
- DEC ketogenesis
Insulin target organs (skeletal muscle)
INC glucose uptake
INC protein synthesis
Insulin target organs (adipose tissue)
- INC glucose uptake
- DEC lipolysis/ketogenesis
Insulin target organs (Pancreas-alpha cells)
DEC glucagon synthesis
What are the consequences of inadequate insulin
- HYPERGLYCEMIA
- polyuria
- polydipsia
- lethargy
- polyphagia or anorexia
- ketosis/ketoacidosis (liver probs)
- muscle wasting, weight loss
TPO jobs
- Iodi-D-e is converted to iodi-N-e (I to I2)
- iodination of thyroglobulin tyrosine residue
- coupling that forms T3 and T4
what helps ocntrol the balance between gluconeogenesis and glycolysis
- fructose 2,6-bisphosphate
- via inverse regulation of phosphofructokinase-1 (PFK1) and fructose 1,6-bisphosphate
hereditary orotic aciduria
- rare AR d/o of de novo pyrimidine synthesis
- CP:
- physical and mental retardation
- megaloblastic anemiaelevated urinary orotic acid
- PP: defect in UMP synthase
- tx: uridine supplementatio to bypass enzymatic defect and imrpove symptoms as uridine is converted to UMP via nucleoside kinases
what is used to control severe Graves ophthalmopathy
- high-dose glucocorticoids: PRednisone
- help DEC the severity of inflammation an DEC extra-ocular volume
- conventional anti-thyroid dx do NOT improve ophthalmopathy
What are four important inherited HYPER-lipoproteinemias
- familial chylomicronemia syndrome (type 1)
- familial hypercholesterolemia (type 2a)
- familial dysbetalipoproteinemia (type 3)
- familial hypertrigyceridemia (type 4)
familial chylomicronemia syndrome (type 1)
- AR
- protein defect:
- lipopotein lipase
- ApoC-2
- elevated lipoproteins: chylomicrons
- major manifestations:
- acute pancreatitis
- lipemia retinalis
- eruptive xanthomas
familial hypercholesterolemia (type 2a)
- protein defect:
- LDL receptor
- ApoB-100
- Elevated lipoprotein: LDL
- major manifestations:
- premature atherosclerosis
- tendom xanthomas
- xanthelasmas
familial dysbetalipoproteinemia (type 3)
- protein defect: ApoE
- elevated lipoproteins:
- chylomicron and VLDL remnants
- major manifestations:
- premature atherosclerosis
- tuboeruptive and palmar xanthomas
familial hypertrigyceridemia (type 4)
- protein defect: polygenic
- elevated lipoproteins: VLDL
- major manifestations:
- assoc with coronary dz
- pancreatitis
- diabetes
GlucagonOMA syndrome
- PP: rare tumor arising from alpha-cells of pancreatic islets of Langerhans
- CP:
- diabetes mellitus
- necrolytic migratory erythema
- painful and pruritic rash
- affects face, groin, extremities
- small erythematous papules/plaques form large lesions with ctl clearing of bronze-colored induration
- anema
- diagnosis made by detecting elevated serum levels of glucagon
