View source for Thyroid

<noinclude>{{Top
|author1=[[User:Mikael Häggström|Mikael Häggström]]
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==Presentations==
*'''[[Hyperthyroidism]]'''
*'''[[Thyroid cytology]]'''
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{{Fixation - standard}} Fix all thyroids at least overnight to avoid artifactual nuclear atypia.<ref name=chicago2>{{cite web|url=https://voices.uchicago.edu/grosspathology/head-neck/thyroid/#primary-column|title=Gross Pathology Manual By The University of Chicago Department of Pathology}} Updated 2-14-19 NAC.</ref>
{{Fixation - general notes}}

==Removal during autopsy==
[[File:Gross pathology of parathyroid gland, annotated.jpg|thumb|210px|'''[[Parathyroid glands]]''' (white arrow), next to the thyroid gland.]]
Sharply dissect the thyroid from the cartilage, starting at the posterior end of each lobe & working forward. Do not cut the isthmus. Try to find parathyroids.

==Gross processing of thyroidectomy==
*'''Weigh'''.<ref name=chicago>{{cite web|url=https://voices.uchicago.edu/grosspathology/head-neck/thyroid/#primary-column|title=Gross Pathology Manual By The University of Chicago Department of Pathology}} Updated 2-14-19 NAC.</ref> Up to 30 g versus over 30 g grams is an accepted cutoff between normal and increased weight of the thyroid gland.<ref name="ShamimMonira1970">{{cite journal|last1=Shamim|first1=A|last2=Monira|first2=K|last3=Manowara|first3=B|last4=Sabiha|first4=M|last5=Alim|first5=A|last6=Nurunnabi|first6=ASM|title=Weight of the Human Thyroid Gland  A Postmortem Study|journal=Bangladesh Journal of Medical Science|volume=9|issue=1|year=1970|pages=44–48|issn=2076-0299|doi=10.3329/bjms.v9i1.5230}}<br>- In turn citing: Langer P. Discussion about the limit between normal thyroid and goiter: mini review. Endocrine regulations. 1999 March; 33(1): 39-45.</ref>
*'''Measure''' each lobe and isthmus in 3 dimensions, respectively.<ref name=chicago/>
*'''Ink''' outer surface,<ref name=chicago/> at least if malignancy is suspected.<ref>{{Stora utskärningen}}</ref>
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File:Grossing of hemithyroidectomy.svg|Hemithyroidecomy (lobe + isthmus) or lobectomy, including completion thyroidectomies: Use separate colors over the cut surface and the outer “capsular” or "peripheral" surface.
File:How to not gross hemithyroidectomy.svg|None of the outer “capsular” surface should be inked like the cut surface.
File:Grossing of thyroidectomy with isthmus.svg|Intact total thyroidectomy: Separate colors for each lobe and the isthmus.
File:Grossing of thyroidectomy without isthmus.svg|If no appreciable isthmus, Separate colors for each lobe.
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{{Comprehensive-begin}}In addition, use different ink colors on the anterior versus posterior “capsular” or "peripheral" surface.{{Comprehensive-end}}

Serially '''section''' the specimen at 3-4mm intervals,<ref>{{cite web|url=https://www.rcpa.edu.au/Manuals/Macroscopic-Cut-Up-Manual/Endocrine/Thyroid|title=THYROID|website=Royal College of pathologists of Australia|accessdate=2019-12-17}}</ref> such as follows:<ref name=chicago/>
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File:Sectioning of hemithyroidectomy.svg|Hemithyroidecomy (lobe + isthmus) or lobectomy: Include isthmic orange margins in your transverse sections.
File:Sectioning of thyroidectomy with isthmus.svg|Intact total thyroidectomy: Transverse lobe sections and sagittal isthmus sections
File:Sectioning of thyroidectomy without isthmus.svg|Short/inconspicious isthmus: The isthmus can be included in the transverse sections.
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{{Gross processing}}<noinclude>

==Microscopic examination==
Look primarily for the most commons causes of the presentation at hand. Otherwise, thyroid nodules can broadly be classified into benign versus malignant, where the risk of malignancy per nodule case is higher in younger people (approximately 23% in people aged 20-30 and approximately 13% in those aged >70 y).<ref name="KwongMedici2015">{{cite journal|last1=Kwong|first1=Norra|last2=Medici|first2=Marco|last3=Angell|first3=Trevor E.|last4=Liu|first4=Xiaoyun|last5=Marqusee|first5=Ellen|last6=Cibas|first6=Edmund S.|last7=Krane|first7=Jeffrey F.|last8=Barletta|first8=Justine A.|last9=Kim|first9=Matthew I.|last10=Larsen|first10=P. Reed|last11=Alexander|first11=Erik K.|title=The Influence of Patient Age on Thyroid Nodule Formation, Multinodularity, and Thyroid Cancer Risk|journal=The Journal of Clinical Endocrinology & Metabolism|volume=100|issue=12|year=2015|pages=4434–4440|issn=0021-972X|doi=10.1210/jc.2015-3100}}</ref> Benign thyroid nodules are generally either follicular adenoma or Hürthle cell adenoma (approximately 60% and 40% of benign nodules, respectively).<ref name="MalithBombil2018">{{cite journal|last1=Malith|first1=V|last2=Bombil|first2=I|last3=Harran|first3=N|last4=Luvhengo|first4=TE|title=Demographic and histological subtypes of Hurthle cell tumours of the thyroid in a South African setting|journal=South African Journal of Surgery|volume=56|issue=3|year=2018|pages=20–23|issn=00382361|doi=10.17159/2078-5151/2018/v56n3a2557}}</ref> <noinclude>See '''[[hyperthyroidism]]''' article for such case presentations.</noinclude>
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File:Histopathology of non-specific chronic thyroiditis.jpg|'''[[Thyroiditis]]''', defined by a significant inflammatory infiltrate, usually lymphocytic.
File:Histopathology of nodular hyperplasia of the thyroid.png|'''[[Thyroid hyperplasia]]''': Variable sized dilated follicles with flattened to hyperplastic epithelium. May form nodules, but without any significant capsule. Architecture resembles normal thyroid, but may be somewhat hypercellular.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/thyroidnodular.html|title=Thyroid & parathyroid - Hyperplasia / goiter - Multinodular goiter|author=Swati Satturwar, M.D., F. Zahra Aly, M.D., Ph.D.|website=PathologyOutlines}} Last author update: 11 June 2021. Last staff update: 18 November 2021</ref>
File:Histopathology of hyperfunctioning and non-hyperfunctioning thyroid follicular adenoma.jpg|'''Thyroid follicular adenoma''', being architecturally and cytologically different from surrounding gland, and being completely enveloped by thin fibrous capsule (if not being encapsulated, mainly consider thyroid carcinoma if atypical cells, otherwise nodular hyperplasia with dominant nodule, the latter especially if there are hyperplastic changes elsewhere in gland).<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/thyroidfollicularadenoma.html|title=Thyroid & parathyroid Benign thyroid neoplasms. Follicular adenoma.|author=Sheren Younes, M.D.|website=Pathology Outlines}} Last author update: 1 November 2014. Last staff update: 8 March 2022</ref> Hyperfunctioning follicular adenoma typically shows follicles with papillary infoldings and bubbly, pale colloid with peripheral scalloping (a). Non-hyperfunctioning adenomas with papillary hyperplasia usually show a more predominantly papillary pattern without vacuolated cytoplasm and scalloping colloid (b).<ref name=Cameselle-Teijeiro2020>{{cite journal| author=Cameselle-Teijeiro JM, Eloy C, Sobrinho-Simões M| title=Pitfalls in Challenging Thyroid Tumors: Emphasis on Differential Diagnosis and Ancillary Biomarkers. | journal=Endocr Pathol | year= 2020 | volume= 31 | issue= 3 | pages= 197-217 | pmid=32632840 | doi=10.1007/s12022-020-09638-x | pmc=7395918 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32632840  }}<br>"This article is licensed under a Creative Commons Attribution 4.0 International License"</ref>
File:Histopathology of NIFTP.png|'''NIFTP''' (noninvasive follicular thyroid neoplasm with papillary-like nuclear features): <ref>Image by Mikael Häggström, MD. Reference for findings: {{cite web|url=https://www.pathologyoutlines.com/topic/thyroidglandniftp.html|title=NIFTP|website=Pathology Outlines|author=Rachel Jug, M.B.B.Ch., B.A.O., David Poller, M.D., Xiaoyin "Sara" Jiang, M.D.}} Last author update: 10 May 2018</ref>
File:Histopathology of a Hürthle cell adenoma.jpg|thumb|'''Hürthle cell adenoma''', typically consisting of cells with large size, distinct cell borders, deeply eosinophilic and granular cytoplasm, large nucleus with prominent nucleolus, and complete loss of cell polarity.<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/thyroidhurthle.html|website=Pathology Outlines|author=Shuanzeng (Sam) Wei, M.D., Ph.D.|title=Thyroid & parathyroid - Other thyroid carcinoma - Main- Oncocytic (Hürthle cell) tumors}} Last author update: 1 October 2017. Last staff update: 21 July 2021</ref>
File:Pie chart of relative incidences of thyroid cancers.png|Relative incidences of '''malignant''' thyroid tumors.
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===Papillary thyroid carcinoma===
A '''[[papillary thyroid carcinoma]]''' is characterized by:
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File:Histopathology of papillary thyroid cancer in a thyroglossal cyst, high magnification, annotated.jpg|'''Pseudonuclear inclusions''' (representing cytoplasmic invaginations)
File:Nuclear grooves.jpg|'''Nuclear grooves'''
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Also, it typically has nuclei with:<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/thyroidpapillary.html|title=Thyroid & parathyroid - Papillary thyroid carcinoma - Papillary thyroid carcinoma overview|website=Pathology Outlines|author=Bin Xu, M.D., Ph.D.}} Topic Completed: 8 January 2020. Minor changes: 28 May 2021</ref>
*Enlargement, elongation, overlapping 
*Chromatin with clearing, margination, glassy / ground glass texture
*Nuclear membrane with irregular contour

===Other thyroid tumors===
<gallery mode=packed heights=230px>
File:Histopathology of follicular thyroid carcinoma.png|'''Follicular thyroid carcinoma''', resembling follicular cells, and typically do not display the nuclear features of papillary thyroid carcinoma mentioned above. Distinction from adenoma requires invasion of adjacent thyroid parenchyma, capsule (complete penetration) and/or blood vessels (in or beyond the capsule).<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/thyroidfollicular.html|title=Thyroid & parathyroid - Other thyroid carcinoma - Follicular|website=Pathology Outlines|author=Shuanzeng (Sam) Wei, M.D., Ph.D.}} Last author update: 1 August 2017. Last staff update: 24 May 2022</ref>
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===Reporting===
{{CAP}}
{{Reporting}}
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==See also==
*[[Parathyroid glands]]
{{Bottom}}
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