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Author: Mikael Häggström [notes 1]


Generally 10% neutral buffered formalin. Fix all thyroids at least overnight to avoid artifactual nuclear atypia.[1]

See also: General notes on fixation

Gross processing

  • Weigh[2]
  • Measure each lobe and isthmus in 3 dimensions, respectively.[2]
  • Ink outer surface,[2] at least if malignancy is suspected.[3]:[notes 2]

Serially section the specimen at 3-4mm intervals,[4] such as follows:[2]

See also: General notes on gross processing

Microscopic evaluation

The most common cause of hyperthyroidism is Grave's disease (50-80% worldwide). Its typical features are:[5]

  • Hyperplastic thyroid follicles with papillary infoldings
  • Diffuse hyperplasia and hypertrophy of follicular cells with retention of lobular architecture
  • Prominent vascular congestion
  • Tall follicular cells with papillae that usually lack fibrovascular cores
  • Nuclei are round, often basally located, and rarely overlap
  • Colloid is typically decreased, and when present it typically has peripheral scalloping
  • Variable patchy lymphoid stromal infiltrate


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
  2. Inking will specify the serosa or resection margin in later histopathologic evaluation.
  3. 3.0 3.1 Separate coloring allows to distinguish the thyroid margin (continuous with the other lobe) from the peripheral margin (towards soft tissues).

Main page


  1. . Gross Pathology Manual By The University of Chicago Department of Pathology. Updated 2-14-19 NAC.
  2. 2.0 2.1 2.2 2.3 . Gross Pathology Manual By The University of Chicago Department of Pathology. Updated 2-14-19 NAC.
  3. Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg. Stora utskärningen. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-26.
  4. . THYROID. Royal College of pathologists of Australia. Retrieved on 2019-12-17.
  5. F. Zahra Aly, M.D., Ph.D., Swati Satturwar, M.B.B.S.. Thyroid gland - Hyperplasia / goiter - Graves disease. PathologyOutlines. Topic Completed: 1 November 2017, Minor changes: 14 March 2019
  6. 6.0 6.1 6.2 6.3 Swati Satturwar, M.B.B.S., F. Zahra Aly, M.D., Ph.D.. Thyroid gland - Hyperplasia / goiter - Multinodular goiter. PathologyOutlines. Topic Completed: 1 February 2018. Minor changes: 14 December 2019