Pathology of thyroid & other common endocrine disorders.

1. Challenge….! Jan 2009: 4 th Year Students at JCU School of Medicine set new record.…!!! 100% Pass & Class Average of over 70% 99% Pass & Class Average of 68% Highest Are you ready for the Challenge….? Yes We Can…!

5. Oprah has battled with her weight for years. Recently she was diagnosed with hyperthyroidism . which sped up her metabolism and prevented sleep. Oprah eventually "blew out" her thyroid and experienced classic symptoms of hypothyroidism : Her metabolism slowed and she felt sluggish and tired. Hyper - - Hypo

6. Sir William Osler, M.D. said… As is our pathology so is our practice... what the pathologist thinks today, the physician does tomorrow. Pathology, The science of Medicine

8. Pathology Lab resources: Muse um Specimens GN-01 Pheochromocytoma GN-02 Adenoma (Hurthle Cell) GR-01 Adrenal Haemorrhage GR-02 Nodular Thyroid GR-03 Nodular Hyperplasia (MNG) GR-04 Benign Nodular Thyroid (MNG) GR-05 Thyroid Cyst Digital Slides Thyroid Graves (JCU slide) Endo-39-Thyroid MNG Endo-40-Adrenal adenoma Endo-46-Pheochromocytoma Endo-47-Hashimoto-Pap ca Endo-51-Hashimotos thyroiditis Endo-52-Hashimotos thyroiditis Endo-53-Graves Endo-54-Hashimotos thyroiditis Endo-57-Pitutary Normal Endo-58-Thyroid Normal Endo-59-Adrenal Normal

10. Major Endocrine Glands: Self Study…..!

11. 8. A PLEASING PERSONALITY WITH PMA Assembling an attractive personality is a must. Your personality is your greatest asset or your greatest liability, for it embraces everything that you control: mind, body, soul and spirit. Learn to be pleasant even when others are being unpleasant to you. Positive Mental Attitude: 17 Success Principles… Some bring happiness where ever they go, & some whenever….!

12. Pathology of Thyroid Disorders Dr. Venkatesh M. Shashidhar Associate Prof. & Head of Pathology

14. Thyroid Examination:

16. Variation in histology:

17. Thyroid Function: Testing

18. Primary – Secondary – Tertiary Gland – Pituitary - Hypothalamus T3/T4 - TSH - TRH

19. Primary hypoThy Seconary hypothy Neoplastic hyperthy Secondary Hyperthy Throid Func. Testing

20. Diagnosing thyroiditis. * RAIU = radioactive iodine uptake

21. Graves Hashimoto

22. Thyroid - Normal

23. Normal Thyroid & Parathyroid

24. Normal Thyroid & Parathyroid Thyroid - Parathyroid

25. Normal Thyroid B A C

26. C cells of thyroid ImmunoPeroxidase stain ? Function ? Tumor

33. Hypothyroidism: Pale gland.

36. Normal - Graves

38. Hyperthyroidism – exophthalmia Note:  Unilateral prominance or Severe 

39. Thyrotoxicosis: Clin Myxedema Alopecia Acropachy Loss of lateral eyebrow Carotenemia -- normal

40. ? Test … ? Result … ? cause Lid Lag…

41. 3. GOING THE EXTRA MILE Very simply, this principle means: Render or give more and better service than you are paid for, and sooner or later you will receive compound interest from your investment of going the extra mile. Positive Mental Attitude: 17 Success Principles…

43. Hashimoto’s Disease Atrophic Thy Fol Ly. Follicle

44. Hashimoto’s Disease Atrophic Thy Fol Ly. Follicle

45. Hashimoto’s – Lymphocytes & Hurthle cells. Lymphocytes Hurthle cells Ly. Follicle

46. Antimicrosomal Ag/Peroxidase (TPO)Ab -ve Colloid +ve Cells

47. Antithyroglobulin Antibody +ve colloid -ve cells

51. Graves Disease Pale, scanty, colloid Papillary ep. hyperplasia Gross: Red, fleshy & smooth

52. Graves… Microscopy: Note: Prominent follicular cells scanty colloid focal lymphoid aggregates Colloid resorption Papillary ep. hyperplasia

53. Graves… Microscopy: Note: Prominent follicular cells scanty colloid focal lymphoid aggregates Lymphoid Follicle Colloid resorption Papillary ep. hyperplasia

55. 14. CREATIVE VISION Creative vision requires you to stimulate your imagination to work towards your goal, your target and your major purpose, and to put the result of that imagination to work. Positive Mental Attitude: 17 Success Principles…

56. GOITRE (Enlargement of Thyroid) Hyperplasia ( MNG ), Inflammation, tumours

60. Endemic Goitre - Euthyroid

61. MNG - Colloid Cyst

62. Nontoxic-Multi Nodular Goitre. A: conspicuous neck mass. B: Coronal section showing numerous irregular nodules, some with hemorrhage. C: Microscopy: variation in the size of the follicles. Note: TSH, T3,T4  Normal (Euthyroid)

63. Multinodular Goitre

64. 5. SELF DISCIPLINE Self discipline is doing what you are supposed to be doing for the moment. It is employing the "DO IT NOW“ philosophy Positive Mental Attitude: 17 Success Principles…

67. Follicular Adenoma

68. Adenoma (Follicular)

69. Carcinoma of Thyroid Type (%) age spread Prognosis Papillary 60-70 young adults 20-40 (<45y) Lymphatic , to local nodes Excellent Follicular 20-25 Young-middle 40-50 (>45) Blood stream, especially to bone Good with radio-iodine therapy. Anaplastic 10-15 Elderly Aggressive local extension Very poor Medullary (C-cells) 5-10 Usually elderly, but familial cases occur Local, lymphatic, blood stream Variable. More aggressive in familial cases

70. Papillary Carcinoma

71. Papillary Carcinoma

72. Papillary Carcinoma Papilla Fibro-vascular core

73. Papillary Carcinoma (follicular pattern) Empty nuclei Fibro-vascular core

74. Papillary Carcinoma Psammoma bodies. Psammoma Body

75. Follicular Carcinoma

76. Follicular Carcinoma

77. Follicular Carcinoma BV invasion Capsule invasion Follicles

78. Follicular Carcinoma BV invasion Capsule invasion Follicles

79. Follicular Adenoma

80. Anaplastic Carcinoma

81. Medullary Carcinoma

82. Amyloid in Medullary Ca (Birefringence)

85. 11. CONTROLLED ATTENTION WITH PMA Controlled attention is organised mind power. It is the highest form of self discipline. Keep your mind on the things you want and off the things you don't want. Positive Mental Attitude: 17 Success Principles…

86. Challenge….! Jan 2009: 4 th Year Students at JCU School of Medicine set new record.…!!! 100% Pass & Class Average of over 70% 99% Pass & Class Average of 68% Highest Are you ready for the Challenge….? Yes We Can…!

87. Pathology of Endocrine System Overview Dr. Shashidhar V. Murthy Senior Lecturer & Head of Pathology James Cook University School of Medicine

91. Normal Pituitary: Post Ant Stalk Post Ant

92. Acromegaly

93. Pituitary Histology: Anterior(adeno hypophysis) - Posterior (Neurohypophysis)

94. Ant (Adeno) – Hypophysis/Pituitary - Post (Neuro)

97. Adrenal Gland

100. Waterhouse-Friderichsen Sy Adrenal hemorrhage

103. Type I MEN Type II PPP * PTAGIn

104. “ One's philosophy is not best expressed in words; it's expressed in the choices one makes. Eleanor Roosevelt1884-1962, U.S. diplomat, author, and political figure. Wife of Franklin D. Roosevelt

106. Test Normal Interpretation &quot;TSH&quot; Test -- Thyroid Stimulating Hormone / Serum thyrotropin 0.3 to 6 Under .4 can indicate possible hyperthyroidism. Over 6 is considered indicative of hypothyroidism. Total T4 / Serum thyroxine 4.5 to 12.5 Less than 4.5 can be indicative of an underfunctioning thyroid when TSH is also elevated. Over 12.5 can indicate hyperthyroidism. Low T4 with low TSH can sometimes indicate a pituitary problem. Free T4 / Free Thyroxine - FT4 0.7 to 2.0 Less than 0.7 is considered indicative of possible hypothyroidism. T3 / Serum triiodothyronine 80 to 220 Less than 80 can indicate hypothyroidism.

107. Hypothalamo-Pituitary-Gland Axis Hypothalamus Pituitary Target Gland Peripheral Inhibitory Hormone CRH ACTH Adrenal Corticosteroids TRH TSH Thyroid T 3 , T 4 GHRH Growth hormone Varied IGF-I Somatostatin Growth hormone Varied IGF-I LHRH LH Gonads Estradiol, testosterone FSH Gonads Inhibin, estradiol, testosterone Dopamine Prolactin Breast Unknown

108. Pemberton’s Sign Within 30 seconds after raising both arms (Pemberton’s maneuver), marked facial plethora develops (Pemberton’s sign) indicating compression of the jugular veins (Panel B) – commonly due to enlarged thyroid. From: NEJM-Images in clinical medicine ( http://content.nejm.org/cgi/reprint/350/13/1338.pdf )

110. DeQuervain's Disease - SAGT

111. Insulinoma: Pancreas Routine H&E Stain Immunoperoxidase for Insulin. Uniform pink cytoplasm. Note: brown cytoplasmic stain. Tumors of Islets are rare. Commonest is benign insulin secreting adenoma – Insulinoma. Others tumors are Gastrinoma – causing Zollinger-Ellison Syndrome. Glucagonoma, VIPoma, somatostatinoma etc.

112. David Thomas You can do what you want to do. You can be what you want to be…!