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Pathology - Hashimoto's thyroiditis
Definition: An autoimmune thyroid disorder marked by generalized thyroid enlargement and elevated levels of thyroid autoantibodies.
Epidemiology • Prevalent, impacting approximately 1% of the population. • Primarily manifests in middle-aged women. Aetiology • Unidentified.
Pathogenesis • Activated CD4+ helper T-cells enlist CD8+ cytotoxic T-cells that annihilate thyroid follicular epithelial cells. • Anti-thyroid autoantibodies generated by activated B-cells may also play a role.
Presentation: Diffuse firm goiter accompanied by characteristics of hypothyroidism.
Biochemistry • Thyroid-stimulating hormone (TSH) and thyroxine (T4). • Autoantibodies against thyroglobulin, thyroid peroxidase, and TSH receptor are typically present. It is important to note that the latter antibody differs from that observed in Graves' illness, as it inhibits the TSH receptor instead of activating it.
Macroscopy • The thyroid exhibits diffuse enlargement and nodularity. • The cut surface is typically soft and white, suggesting lymphoid tissue. Cytopathology • Aspirates are cellular, comprising numerous lymphoid cells and few follicular epithelial cells exhibiting Hurthle cell transformation. • Hurthle cells include ample granular cytoplasm and expanded nuclei with vesicular chromatin.
Histopathology • The thyroid has extensive lymphoid infiltration accompanied by the establishment of germinal centers. • Thyroid follicles are atrophic and demonstrate widespread Hurthle cell transformation, marked by copious eosinophilic granular cytoplasm and nuclear expansion.
Prognosis: Favorable with thyroxine replacement therapy. 2 The incidence of thyroid lymphoma, typically extranodal marginal zone B-cell lymphoma, has risen.
Definition: An autoimmune thyroid disorder marked by generalized thyroid enlargement and elevated levels of thyroid autoantibodies.
Epidemiology • Prevalent, impacting approximately 1% of the population. • Primarily manifests in middle-aged women. Aetiology • Unidentified.
Pathogenesis • Activated CD4+ helper T-cells enlist CD8+ cytotoxic T-cells that annihilate thyroid follicular epithelial cells. • Anti-thyroid autoantibodies generated by activated B-cells may also play a role.
Presentation: Diffuse firm goiter accompanied by characteristics of hypothyroidism.
Biochemistry • Thyroid-stimulating hormone (TSH) and thyroxine (T4). • Autoantibodies against thyroglobulin, thyroid peroxidase, and TSH receptor are typically present. It is important to note that the latter antibody differs from that observed in Graves' illness, as it inhibits the TSH receptor instead of activating it.
Macroscopy • The thyroid exhibits diffuse enlargement and nodularity. • The cut surface is typically soft and white, suggesting lymphoid tissue. Cytopathology • Aspirates are cellular, comprising numerous lymphoid cells and few follicular epithelial cells exhibiting Hurthle cell transformation. • Hurthle cells include ample granular cytoplasm and expanded nuclei with vesicular chromatin.
Histopathology • The thyroid has extensive lymphoid infiltration accompanied by the establishment of germinal centers. • Thyroid follicles are atrophic and demonstrate widespread Hurthle cell transformation, marked by copious eosinophilic granular cytoplasm and nuclear expansion.
Prognosis: Favorable with thyroxine replacement therapy. 2 The incidence of thyroid lymphoma, typically extranodal marginal zone B-cell lymphoma, has risen.
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