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