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    7 Thyroid Gland

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    Nipun Shamika
    The thyroid gland normally contains follicles lined with cuboidal cells and filled with colloid. Two common pathological conditions are thyroiditis, an inflammatory condition, and Graves' disease, an autoimmune condition causing hyperthyroidism. Hashimoto's thyroiditis is a chronic autoimmune thyroiditis that usually results in hypothyroidism. Graves' disease causes hyperthyroidism and is associated with eye changes. Goiter is thyroid enlargement usually due to iodine deficiency. Nodular goiter contains multiple nodules. Common thyroid tumors include follicular adenomas, follicular and papillary carcinomas, and rare aggressive anaplastic and medullary carcinomas. Thyroid fine needle aspiration cyt

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    7 Thyroid Gland

    Uploaded by

    Nipun Shamika
    40 views40 pages
    The thyroid gland normally contains follicles lined with cuboidal cells and filled with colloid. Two common pathological conditions are thyroiditis, an inflammatory condition, and Graves' disease, an autoimmune condition causing hyperthyroidism. Hashimoto's thyroiditis is a chronic autoimmune thyroiditis that usually results in hypothyroidism. Graves' disease causes hyperthyroidism and is associated with eye changes. Goiter is thyroid enlargement usually due to iodine deficiency. Nodular goiter contains multiple nodules. Common thyroid tumors include follicular adenomas, follicular and papillary carcinomas, and rare aggressive anaplastic and medullary carcinomas. Thyroid fine needle aspiration cyt

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    The thyroid gland normally contains follicles lined with cuboidal cells and filled with colloid. Two common pathological conditions are thyroiditis, an inflammatory condition, and Graves' disease, an autoimmune condition causing hyperthyroidism. Hashimoto's thyroiditis is a chronic autoimmune thyroiditis that usually results in hypothyroidism. Graves' disease causes hyperthyroidism and is associated with eye changes. Goiter is thyroid enlargement usually due to iodine deficiency. Nodular goiter contains multiple nodules. Common thyroid tumors include follicular adenomas, follicular and papillary carcinomas, and rare aggressive anaplastic and medullary carcinomas. Thyroid fine needle aspiration cyt

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    40 views40 pages

    7 Thyroid Gland

    Uploaded by

    Nipun Shamika
    The thyroid gland normally contains follicles lined with cuboidal cells and filled with colloid. Two common pathological conditions are thyroiditis, an inflammatory condition, and Graves' disease, an autoimmune condition causing hyperthyroidism. Hashimoto's thyroiditis is a chronic autoimmune thyroiditis that usually results in hypothyroidism. Graves' disease causes hyperthyroidism and is associated with eye changes. Goiter is thyroid enlargement usually due to iodine deficiency. Nodular goiter contains multiple nodules. Common thyroid tumors include follicular adenomas, follicular and papillary carcinomas, and rare aggressive anaplastic and medullary carcinomas. Thyroid fine needle aspiration cyt

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    Thyroid Gland

    Dr. Manella Joseph


    Normal structure
    Cont…
    • Colloid filled acini.
    • Acini lined by cuboidal epithelium
    • Acini form lobules enclosed by thin fibrovascular septae
    • Colloid contain thyroglobulin
    • Calcitonin secreting “C” cells found among follicular cells
    Thyroiditis
    • Acute – rare
    • Sub acute – granulomatous thyroiditis
    • Chronic – autoimmune thyroiditis (Hashimoto’s thyroiditis)
    - Riedel’s thyroiditis
    Hashimoto’s thyroiditis
    (Other terms – autoimmune, chronic lymphocytic)
    • Diffuse enlargement of thyroid
    • Lymphoplasmacytic infiltration
    • +ve thyroid auto antibodies

    • Females > males


    • ~30 – 50 years
    • Usually results in hypothyroidism (rarely – Hashitoxicosis)
    Cont…
    • Morphology
    Gross – diffuse, symmetric, firm, rubbery enlargement

    • Microscopy
    fig 25.7
    Cont…
    Etiopathogenesis
    • Autoimmune nature is well established
    • Initial activation of CD4+ T helper cells induce infiltration of
    CD8+ cytotoxic T cells
    Activation of B cells
    producing auto antibodies
    • Auto antibodies detected in serum of patients
    - Thyroid microsomal auto antibodies
    - Thyroglobulin antibodies
    - TSH receptor auto antibodies
    Graves’ Disease (Diffuse Toxic Goitre)
    [primary hyperplasia]
    • Triad of features
    - Hyperthyroidism (Thyrotoxicosis)
    - Diffuse thyroid enlargement
    - Ophthalmopathy

    • Females
    • 30 – 40 years
    • Etiopathogenesis – autoimmune disease
    • Associated factors
    - Genetic
    - Association with other autoimmune diseases E.g. Hashitoxicosis
    - Associated with emotional stress and smoking
    • Serum auto antibodies – TSH receptor auto antibodies
    • The ophthalmopathy is also of autoimmune origin
    Morphology
    • Gross – moderate, diffuse, symmetrical enlargement of thyroid

    • Micro
    Goitre
    • Thyroid enlargement caused by compensatory hyperplasia and
    hypertrophy of the follicular epithelium in response to thyroid
    hormone deficiency
    • Commonest cause – iodine deficiency
    • Also – goitrogens E.g. Cabbage, cauliflower, turnips
    • Drugs treated for hyperthyroidism
    Microscopy
    Simple Goitre
    Macroscopy
    Nodular Goitre
    Nodular Goitre
    Thyroid tumors
    Benign Malignant
    Commoner

    Follicular Adenoma
    • Solitary nodule approximately 3 cm in diameter, (spherical)
    • Complete encapsulation
    • Distinct architecture – different growth patterns microfollicular
    macrofollicular
    trabecular etc
    Cont
    • Fig 25.14/25.15a etc
    Follicular carcinoma
    • Middle to old age
    • Females > males
    • Macroscopy –
    encapsulated nodule
    • Microscopy
    Papillary carcinoma
    • Most common thyroid carcinoma
    • All ages
    • Females > males
    • Slow growing, usually present as a solitary nodule
    • Lymph node involvement common
    • Distant metastasis rare
    • Macroscopy – microscopic foci to larger nodules
    • Grayish white firm area
    Cont…
    • Microscopy
    • Distinct features
    - Papillary pattern
    - Tumor cell features
    - Psammoma bodies
    Anaplastic carcinoma (undifferentiated)
    • Less common
    • Old age
    • Aggressive – rapidly growing
    • Involving neighboring structures leading to pressure symptoms
    • Lymphatic and hematogenous spread
    • Macroscopy – large tumor, white and tan with necrosis and
    hemorrhage
    • Microscopy
    Small cell/ spindle cell/ giant cell
    Anaplastic Carcinoma
    Medullary Carcinoma
    • Derived from parafollicular C cells
    • Less frequent
    • May present as solitary nodule thyroid/ enlarged cervical lymph node
    • Secrete calcitonin (Hypocalcaemic Hormone)
    • Stroma contain amyloid
    • Can occur sporadically or familial
    • Familial ones associated with other endocrine tumors
    • Macro – solitary/ bilateral and multicentric.
    • Gray white, firm with necrosis and hemorrhage
    Medullary Carcinoma
    Role of cytology in the diagnosis of Thyroid
    lesions
    • Common practice
    • Diagnosis of neoplastic and non neoplastic conditions
    • Usefulness
    - Exposed organ
    - Biopsy not possible due to extensive vascularity
    • Done – unaided or radiologically guided
    Observations – cells and background
    • Cells – epithelial (number, arrangement, morphology)
    - inflammatory cells (types)
    • Background (blood, amount of colloid, nature of colloid, necrotic debris)

    Interpretation
    • Colloid nodule/ colloid goiter
    • Thyroiditis (lymphocytic, Hashimoto’s, Dequavain’s)
    • Thyrotoxicosis
    • Follicular neoplasm
    • Papillary carcinoma
    • Anaplastic carcinoma
    Usually a suggestive diagnosis

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