Hyperthyroidism
Author:
Mikael Häggström [notes 1]
Fixation
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]
Hemithyroidecomy (lobe + isthmus) or lobectomy, including completion thyroidectomies: Use separate colors over the cut surface and the outer “capsular” surface.[notes 2]
None of the outer “capsular” surface should be inked like the cut surface.[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.
- Typically decreased colloid amount, and when present it typically has peripheral scalloping.
- Variable patchy lymphoid stromal infiltrate.
Toxic multinodular goiter, whose typical findings are:
- Variably dilated follicles with flattened hyperplastic epithelium.[6]
- Nodules may be present[6] (but lack thick capsule in contrast to adenomas).
- Potentially focal fresh or old hemorrhages, rupture of follicles with granulomatous inflammation, fibrosis, calcification and even osseous metaplasia.[6]
- Also potentially papillary projections (Sanderson polsters) that may mimic papillary carcinoma, but they lack malignant nuclear features.[6]
Notes
- ↑ 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.
- ↑ 2.0 2.1 Separate coloring allows to distinguish the thyroid margin (continuous with the other lobe) from the peripheral margin (towards soft tissues).
Main page
References
- ↑ . Gross Pathology Manual By The University of Chicago Department of Pathology. Updated 2-14-19 NAC.
- ↑ 2.0 2.1 2.2 2.3 . Gross Pathology Manual By The University of Chicago Department of Pathology. Updated 2-14-19 NAC.
- ↑ Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg. Stora utskärningen. KVAST (Swedish Society of Pathology). Retrieved on 2019-09-26.
- ↑ . THYROID. Royal College of pathologists of Australia. Retrieved on 2019-12-17.
- ↑ 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
- ↑ 6.0 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