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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]

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.


  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. 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


  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