Section B ENDOCRINE SYSTEM:

Group 8
THYROID
THYROID GLAND
• Located below and anterior to larynx
• Two bulky lateral lobes connected by a thin
isthmus
• Divided into lobules composed of 20-40 follicles
full of PAS-positive thyroglobulin
• LE: cuboidal to columnar epithelium
HASHIMOTO THYROIDITIS
• Cause
• Pathogenesis
• Gross morphology
• Micro morphology
• Clinical course
NEOPLASMS OF THE THYROID
• A nodule is a palpable discrete swelling
• Single nodules are 4x more common in women
• Majority of solitary nodules are localized
nonneoplastic lesions or benign neoplasms
• Benign neoplasms outnumber thyroid CA by a ratio of
10:1
 • Solitary nodules are more likely to be
neoplastic
• Nodules in younger patients are more
likely to be neoplastic
• Nodules in males are more likely to be
Clinical criteria neoplastic
as to the • History of radiation treatment to head and
neck is associated with a n increase
nature of incidence of thyroid malignancy
nodule • Functional nodules that take up
radioactive iodine in imaging studies (hot
nodules) are more likely benign
• More definitive evaluation: fine needle
aspiration or surgical resection.
 More then 85% of thyroid
carcinoma cases

Papillary
Derived from thyroid follicular
Carcinoma of epithelium
the Thyroid

Well differentiated lesions

Pathogenesis
• Genetic factors:
• Genetic alterations in growth factor receptor
signaling pathways
• Gain of function mutations involving genes
encoding the RET or NRTK1 receptor tyrosine
kinase, in the serine/threonine kinase BRAF in the
MAPL pathway
• Constitutive activation, excessive cellular
proliferation and increased cell survival
RET gene
• Located in chromosome 10q11
• Paracentric inversion of chromosome 10
• reciprocal translocation of chromosome 10 and 17
• Forms novel fusion genes called RET/PTC (RET/ Papillary Thyroid
Carcinoma)
• PTC1 and PTC2 are most common
• Higher due to radiation exposure
NTRK1 gene
• Paracentric inversion or translocation of NTRK1 on chromosome 1q21
• Produce constitutively active NTRK1 fusion proteins
BRAF gene
• Intermediate signaling component in the MAP kinase pathway
• One third to one half of papillary carcinoma is of BRAF mutation
• Valine to Glutamate change in codon 600\
• Adverse prognostic factors ( metastatic diseases and extrthyroidal
extension)
• Environmental Factors:
• Major risk factor is exposure to IONIZING RADIATION,
particularly during the first 2 decades of life.
• Deficiency of dietary iodine associated with goiter
Morphology
GROSS FEATURE
Can be solitary or multifocal
Can be well circumscribed or can
infiltrate adjacent parenchyma
May contain areas of fibrosis amd
calcification
Often cystic
Cut surface reveals PAPILLARY FOCI
that point to the diagnosis