Hyperthyroidism: Difference between revisions
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[[File:Causes of hyperthyroidism.png|thumb|Most common causes of hyperthyroidism by age.<ref>{{cite journal|last1=Carlé|first1=Allan|last2=Pedersen|first2=Inge Bülow|last3=Knudsen|first3=Nils|last4=Perrild|first4=Hans|last5=Ovesen|first5=Lars|last6=Rasmussen|first6=Lone Banke|last7=Laurberg|first7=Peter|title=Epidemiology of subtypes of hyperthyroidism in Denmark: a population-based study|journal=European Journal of Endocrinology|volume=164|issue=5|year=2011|pages=801–809|issn=0804-4643|doi=10.1530/EJE-10-1155|pmid=21357288}}</ref>]] | |||
{{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 - 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}} | {{Fixation - general notes}} | ||
==Gross processing== | |||
As per standard for '''[[thyroid]]'''. | |||
==Microscopic evaluation== | ==Microscopic evaluation== | ||
<gallery mode=packed> | The most common cause of hyperthyroidism is Grave's disease (50-80% worldwide). Its typical features are:<ref>{{cite web|url=http://www.pathologyoutlines.com/topic/thyroidgraves.html|title=Thyroid gland - Hyperplasia / goiter - Graves disease|author=F. Zahra Aly, M.D., Ph.D., Swati Satturwar, M.B.B.S.|website=PathologyOutlines}} Topic Completed: 1 November 2017, Minor changes: 14 March 2019</ref> | ||
File:Histopathology of Graves' disease - low mag.jpg|Graves' disease - low magnification: exuberant papillary hyperplasia. | *'''Hyperplastic''' thyroid follicles with papillary infoldings. | ||
File:Histopathology of Graves' disease - medium mag.jpg|Graves' disease - medium magnification: cells with round nuclei and even chromatin pattern lining the papillae. | *Diffuse '''hyperplasia and hypertrophy''' of follicular cells with retention of lobular architecture. | ||
File:Histopathology of amiodarone associated follicular cell damage - high mag.jpg|Amiodarone associated follicular cell damage - high magnification: large thyroid follicles filled with colloid and numerous histiocytes | *Prominent vascular '''congestion'''. | ||
File:Histopathology of amiodarone associated follicular cell damage - low mag.jpg|Amiodarone associated follicular cell damage - low magnification: large thyroid follicles filled with colloid and numerous histiocytes (arrow heads) | *'''Tall follicular cells''' with papillae that usually lack fibrovascular cores. | ||
File:Histopathology of papillary hyperplastic nodule - high mag.jpg|Papillary hyperplastic nodule - high magnification: oncocytic cells lining the papillary structures (arrow) | *'''Nuclei are round''', often basally located, and rarely overlap. | ||
File:Histopathology of papillary hyperplastic nodule - low mag.jpg|Papillary hyperplastic nodule - low magnification: cystic nodule with papillary architecture (arrow) | *Typically '''decreased colloid''' amount, and when present it typically has peripheral scalloping. | ||
*Variable patchy lymphoid stromal '''infiltrate'''. | |||
<gallery mode=packed heights=200> | |||
File:Histopathology of Graves' disease - low mag.jpg|'''Graves' disease''' - low magnification: exuberant papillary hyperplasia. | |||
File:Histopathology of Graves' disease - medium mag.jpg|'''Graves' disease''' - medium magnification: cells with round nuclei and even chromatin pattern lining the papillae. | |||
File:Histopathology of multinodular toxic goiter.jpg|'''Toxic multinodular goiter''', whose typical findings are:<br>- Variably dilated follicles with flattened hyperplastic epithelium.<ref name=POMultinodular>{{cite web|url=http://www.pathologyoutlines.com/topic/thyroidnodular.html|title=Thyroid gland - Hyperplasia / goiter - Multinodular goiter|website=PathologyOutlines|author=Swati Satturwar, M.B.B.S., F. Zahra Aly, M.D., Ph.D.}} Topic Completed: 1 February 2018. Minor changes: 14 December 2019</ref><br>- Nodules may be present<ref name=POMultinodular/> (but lack thick capsule in contrast to adenomas).<br>- Potentially focal fresh or old hemorrhages, rupture of follicles with granulomatous inflammation, fibrosis, calcification and even osseous metaplasia.<ref name=POMultinodular/><br>- Also potentially papillary projections (Sanderson polsters) that may mimic papillary carcinoma, but they lack malignant nuclear features.<ref name=POMultinodular/> | |||
File:Histopathology of amiodarone associated follicular cell damage - high mag.jpg|'''Amiodarone associated follicular cell damage''' - high magnification: large thyroid follicles filled with colloid and numerous histiocytes | |||
File:Histopathology of amiodarone associated follicular cell damage - low mag.jpg|'''Amiodarone associated follicular cell damage''' - low magnification: large thyroid follicles filled with colloid and numerous histiocytes (arrow heads) | |||
File:Histopathology of papillary hyperplastic nodule - high mag.jpg|'''Papillary hyperplastic nodule''' - high magnification: oncocytic cells lining the papillary structures (arrow) | |||
File:Histopathology of papillary hyperplastic nodule - low mag.jpg|'''Papillary hyperplastic nodule''' - low magnification: cystic nodule with papillary architecture (arrow) | |||
</gallery> | </gallery> | ||
{{Bottom}} | {{Bottom}} | ||
Latest revision as of 13:35, 9 January 2023
Author:
Mikael Häggström [note 1]
Fixation
Generally 10% neutral buffered formalin. Fix all thyroids at least overnight to avoid artifactual nuclear atypia.[2]
See also: General notes on fixation
Gross processing
As per standard for thyroid.
Microscopic evaluation
The most common cause of hyperthyroidism is Grave's disease (50-80% worldwide). Its typical features are:[3]
- 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.
-
Graves' disease - low magnification: exuberant papillary hyperplasia. -
Graves' disease - medium magnification: cells with round nuclei and even chromatin pattern lining the papillae. -
![Toxic multinodular goiter, whose typical findings are: - Variably dilated follicles with flattened hyperplastic epithelium.[4] - Nodules may be present[4] (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.[4] - Also potentially papillary projections (Sanderson polsters) that may mimic papillary carcinoma, but they lack malignant nuclear features.[4]](https://upload.wikimedia.org/wikipedia/commons/c/c0/Histopathology_of_multinodular_toxic_goiter.jpg?utm_source=commons.wikimedia.org&utm_campaign=imageinfo&utm_content=original)
Toxic multinodular goiter, whose typical findings are:
- Variably dilated follicles with flattened hyperplastic epithelium.[4]
- Nodules may be present[4] (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.[4]
- Also potentially papillary projections (Sanderson polsters) that may mimic papillary carcinoma, but they lack malignant nuclear features.[4] -
Amiodarone associated follicular cell damage - high magnification: large thyroid follicles filled with colloid and numerous histiocytes -
Amiodarone associated follicular cell damage - low magnification: large thyroid follicles filled with colloid and numerous histiocytes (arrow heads) -
Papillary hyperplastic nodule - high magnification: oncocytic cells lining the papillary structures (arrow) -
Papillary hyperplastic nodule - low magnification: cystic nodule with papillary architecture (arrow)
![Toxic multinodular goiter, whose typical findings are: - Variably dilated follicles with flattened hyperplastic epithelium.[4] - Nodules may be present[4] (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.[4] - Also potentially papillary projections (Sanderson polsters) that may mimic papillary carcinoma, but they lack malignant nuclear features.[4]](/File:Histopathology_of_multinodular_toxic_goiter.jpg)
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.
Main page
References
- ↑ Carlé, Allan; Pedersen, Inge Bülow; Knudsen, Nils; Perrild, Hans; Ovesen, Lars; Rasmussen, Lone Banke; Laurberg, Peter (2011). "Epidemiology of subtypes of hyperthyroidism in Denmark: a population-based study ". European Journal of Endocrinology 164 (5): 801–809. doi:. ISSN 0804-4643. PMID 21357288.
- ↑ . Gross Pathology Manual By The University of Chicago Department of Pathology. Updated 2-14-19 NAC.
- ↑ 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
- ↑ 4.0 4.1 4.2 4.3 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
Image sources