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Pathology of Thyroid Diseases
Thyroid Follicle
Cuboidal epithelium
Thyroid Gland Filled with Colloid
Anterior surface Parafollicular “C” cells
Right, Left Lobe
Connected by narrow Isthmus
Hypothalamus-Pituitary-Thyroid Axis
Hyperthyroidism Hypothyroidism
Clinical syndrome which results from 1°
exposure of b ody tissues to excess • Developmental
circulating levels of free thyroid (Thyroid Dysgenesis)
hormones • Thyroid Hormone Resistance
Hypermetabolic state Syndrome
Due to over activity of • Post-ablative (Surgery, Radioiodine,
Sympathetic Nervous System External Radiation) Congenital Anomalies of Thyroid Gland
Causes • Autoimmune Normal Development
• Graves’ Disease (95%) (Hashimoto Thyroiditis) Evagination of developing pharyngeal epithelium
• Multinodular Goiter with Toxic • Iodine Deficiency that descends as part of Thyroglossal duct
Nodule (Toxi c nodular goiter) • Drugs (Lithium, Iodides, from Foramen Cecu m (at base of tongue) → Anterior Neck
• Functioning Follicular Adenoma/ p-adminosalicylic acid ) Ectopic Thyroid Tiss ue
Carcinoma • Congenital Biosynthetic Defect Lingual Thyroid (base of tongue)
• TSH secreting Pituitary Adenoma (Dyshormonogenetic Goiter) Sites Abnormally High in Neck
(2°) 2° Substernal Thyroid Gland due to Excessive Descend
• Germ Cell Tumour • Hypothalamic Disorder Thyroglossal duct or cyst
(Strauma ovarii, Choriocarcinoma) Congenital anomalies
• Pituitary Failure
• Thyroiditis (Hashimoto Thyroiditis) Persistent sinus remain as a vestigial remnant of
Infant/ Early Childhood (Cretinism)
• Hypothalamic Disorder (↑ TRH) Impaired development of skeletal tubular development of thyroid gland
system, CNS, intellectual growth Part of tube may be obliterated leaving small segments to form cysts
(filled with mucinous secretion )
• Mental Retardation
Site
• Short Stature
• Midline of Neck
• Coarse Facial Features
• Anterior to Trachea
• Protruding Tongue
• Base of Tongue → Normal Position of Thyroid Gland
• Umbilical Hernia
Older Child/ Adult (Myoedema)
Slowing of Physical, Mental Activity
Serum TSH
↑ Sensitive Screening Test
Thyroiditis
Inflammation of Thyroid Gland
Infectious, Non -In fectious
Hashimoto Thyroiditis (Chronic Lymphocytic Thyroiditis)
Subacute Granulomatous Thyroiditis (DeQuervain Thyroiditis)
Subacute Lymphocytic Thyroiditis Sites of Thyroglossal Duct/ Cyst Thyroglossal Cyst
jslum.com | Medicine
Gross
Diffusely Enlarged Thyroid Gland
Pale, Gray-Tan, Firm, Nodular (somewhat)
Atrophic Gland after Fibrosis
Subacute Granulomatous Thyroi ditis
Histology Foreign body Giant Cells (GC)
Extensive Infiltration of Parenchyma by Mononuclear
Destruction of Thyroid Follicles
Inflammatory Infiltrate, Fibrosis
• Lymphocytes
• Plasma Cells
• Well Developed Germinal Centers
Thyroid Follicles
• Atrophic
• Lined by Hurthle cells (Eosinophilic granular cytoplasm)
Interstitial Connective Tissue ↑, Abundant
Gross
Diffusely Enlarge Gland with Soft, Meaty Appearance
resembling normal muscle
Histology
Crowding of Follicular Epithelium
Hashimoto’s Thyroiditis Small Papillae projecting into Lumen, Encroach on Colloid
Symmetrically Atrophic Thyroid Gland Papillae Colloid
Lack of Pale
Fibrovascular cores Scalloped Margin
Graves Disease
Diffuse Hyperplasia
Uniform, Diffuse Enlargement
Hashimoto’s Thyroiditis Red Meaty appearance
Lymphoid Follicle (LF)
Atrophic Thyroid Follicle (TF)
Diffuse Goiter
Mass Effect of Enlarged Thyroid Gland
Multinodular Goitre
Multinodular Goitre
Nodular Enlargement of Thyroid gland
Multiple Nodules
Irregular Nodularity on surface Areas of Cystic Degeneration,
Haemorrhage, Fibrosis, Calcification
Follicular Adenoma
Gross Histology
Solitary, Spherical, Encapsulated, Constituent cells form unifor m-appearing Follicles containing Colloid
Well-demarcated from surroun ding parenchyma Epithelial cells vary in Cell, Nuclear Morphology
Average size – 3cm in diameter (Hurthle cell adenoma, Clear cell carcinoma, Signet ring cell adenoma)
Bulging, Compress Adjacent Thyroid, Gray-White → Brown Hallmark
Intact, Well formed capsule encircling tumor (distinguish from follicular carcinoma )
Follicular Adenoma
Focal Haemorrhagic area
Adenoma of Thyroid
Well circumscribed tumour
Sharp line of demarcation between tumour, Follicular Adenoma
adjacent thyroid tissue (arrow) Intact Fibrous Capsule
Follicular Adenoma
Solitary, Well-Circumscribed Nod ule
Surrounded by a
Thin White Capsule
Follicular Carcinoma
Metastatic Invasion into Bone
Papillary Carcinoma of Thyroid
Medullary Carcinoma
Solid Pattern of Growth
Deposition of Amyloid
Medullary Carcinoma
Papillary Carcinoma of Thyroid +ve Immunohistochemical Stain
Papillary Carcinoma of Thyroid Psammoma Bodies Calcitonin
Nuclear Inclusion (arrow) (Fine Needle Aspiration Smear)