PATHOGENESIS OF THYROID

SWELLING

By
Maria Sahaya Leora.R
Mishpa.Y S
Mogal Alsheefa Sulthana
 Thyroid Enlargement

The normal thyroid gland is impalpable.

The term goitre is used to describe generalized enlargement of
the thyroid gland
A discrete swelling in one lobe with no palpable abnormality
elsewhere is termed an isolated swelling
Discrete swellings with evidence of abnormality elsewhere in
the gland are termed dominant
 Pathogenesis of thyroid swelling in simple goitre

❑ Simple goitre may develop as a result of stimulation of the

thyroid gland by TSH,either as result of inappropriate
secretions from a microadenoma in the anterior pituitary or
in response to a level of circulating throid hormones
❑ Iodine deficiency plays a major role here
❑ Dyshormonogenesis
❑ goitrogens
 Pathogenesis of thyroid swelling in Graves disease
❑ In patients with graves disease TSH works on the Tsh receptor
❑ This leads to the release of T3 and T4
❑ These patients have a autoantibody known as long acting thyroid
stimulator
❑ The LATS stimulates the TSH receptor
❑ Secretion of T3 and T4 increases as the TSH receptor is stimulated
❑ This causes feedback inhibition of TSH
❑ Hence the thyroid profile of patients with Graves disease is increased
T3,T4 and decreased TSH
❑ Hence the patients have thyroidal swelling with hyperthyroidism
 Pathogenesis of Hashimoto thyroiditis

❑ There is conversion of thyroid tissue into lymphoid tissue

❑ The major problem is that there is CD4 mediated CD8
❑ Because of this there is permanent destruction of thyroid
follicles
❑ The permanent destruction of thyroid follicles leads to
permanent hypothyroidism with thyroidal enlargement
Pathogenesis of thyroid swelling in multinodular goitre
Neoplasm

❑Benign tumours are rare and can be either papillary adenoma or

follicular adenoma .
They present as solitary nodule.

❑Malignant tumour are follicular ,papillary,medullary,anaplastic.

Papillary carcinoma
❑It is made of colloid filled follicles with papillary projections.
❑In some cases calcific lesions are found called psammoma bodies
❑Characteristic pale empty nuclei called orphan annie eye nuclei
are seen .

❑It can present as cystic lesions and can be multifocal

❑Involving both lobes.
Follicular carcinoma

Typical features are capsular invasion ,angioinvasion.

It is more aggressive tumour and spread mainly thorough
blood into the bones
Lungs,liver.
Medullary carcinoma
● It arise from the parafollicular c cell.It has got a characteristic
amyloid stroma
● These tumors are not TSH-dependent and do not take up
radioactive iodine.
● It spread through lymphatics and blood.
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