Histopathological pattern of thyroid diseases and its correlation with post-thyroidectomy hypocalcemia: a prospective study in iodine-sufficient Southern India

Background: Increasing incidence of thyroid diseases requiring surgery and postoperative hypocalcemia after total thyroidectomy (TT) remains a concern. This prospective study evaluated the correlation between the histopathologic pattern of thyroid disease and the development of temporary and permanent hypocalcemia (>6 month) post-TT.Methods: Demographics and clinical profile of consecutive patients undergoing TT were documented. The final diagnosis was confirmed with histopathological examination (HPE) of thyroidectomy specimen. Serum corrected-calcium and intact parathormone was measured at baseline, 48-hour and 6-month post-TT.Results: Out of 328 subjects (mean age=35.5 year; M:F=65:263), 33.4% (n=109) and 7.6% (n=26) developed temporary and permanent hypocalcemia [calcium=8 mg/dl] post-TT. HPE comprised colloid goitre 33.2% (n=109), follicular adenoma 1.8% (n=6), Hashimoto’s/lymphocytic thyroiditis 16.8% (n=55), Graves’ disease 14% (n=46), adenomatous hyperplasia 19.8% (n=65), papillary thyroid carcinoma (PTC) 13.4% (n=44), follicular carcinoma 0.3% (n=1), medullary carcinoma 0.3% (n=1) and anaplastic carcinoma 0.3% (n=1). Multinomial regression analysis revealed that temporary hypocalcemia was associated with graves’ disease (Odds ratio: 11.6), PTC (10.3), follicular adenoma (16.7) and thyroiditis (17.5), while permanent hypocalcemia was associated only with thyroiditis (3.2), each p<0.01.Conclusions: Graves’ disease, thyroiditis and malignancy increased the risk of temporary post-thyroidectomy hypocalcemia by many-fold. Subjects with thyroiditis had 3.2-fold increased likelihood for developing permanent hypocalcemia. Hence thyroiditis, a benign pathology warrants high threshold for surgery with meticulous intraoperative dissection and in-situ preservation of parathyroid glands.

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Malignancy in Clinically Non-toxic Multinodular Goiter

Ibrahim Cardiac Medical Journal ◽

10.3329/icmj.v10i1-2.54012 ◽

2021 ◽

Vol 10 (1-2) ◽

pp. 84-88

Author(s):

Mohd Shahjahan Ali ◽

Md Habibullah Sarkar ◽

Syeda Momena Hossain

Keyword(s):

Total Thyroidectomy ◽

Multinodular Goiter ◽

Histopathological Examination ◽

Follicular Adenoma ◽

Cervical Lymphadenopathy ◽

Follicular Carcinoma ◽

Chronic Thyroiditis ◽

College Hospital ◽

Toxic Multinodular Goiter ◽

Thyroid Swelling

Objective: Goiter is a common form of thyroid swelling among population living in areas of iodine deficiency. Of the goiters, non-toxic multinodular goiter (MNG) is the most common and benign form of thyroid disease. However, studies have shown that long-standing MNGs may harbour malignancy. The present study was, therefore, undertaken to ascertain the prevalence of malignancy in clinically diagnosed non-toxic MNGs. Methods: This cross-sectional study was conducted in the Department of Surgery (all four-units) and ENT Department, Rajshahi Medical College Hospital, Rajshahi from July 2007 to June 2008 on 100 patients of clinically non-toxic MNG who underwent thyroid surgery. Biopsy materials were taken from the excised nodules and were sent for histopathological examination to see what proportion of them harboured malignancy. Result: The findings of the study showed that 40% of patients were 30-40 years old with mean age of the patients being 35.5 ± 10.1 (range: 14-75) years. Majority (87%) of the patients was female. Half of the patients with non-toxic MNGs had a history of thyroid swelling for 1-5 years and the rest half for > 5 years with median duration of illness being 5.5 years (range: 1-30 years). Of the 100 patients 4% had stridor and 6% dyspnoea; dysphagia and cervical lymphadenopathy each was 6%. Nearly 60% of the patients had goiter of size 15 sq-cm or below. Sub-total thyroidectomy was the most common operation performed (33%) followed by right hemi-thyroidectomy (24%), near total thyroidectomy (20%), left hemi-thyroidectomy (18%) and total thyroidectomy (5%). Histopathological examination of resected specimens revealed that 15% of the MNGs had malignancy with papillary to follicular carcinoma ratio being 4:1. Histopathological typing showed that 79% was simple MNGs, 4% follicular adenoma, 12% papillary carcinoma, 3% follicular carcinoma and 2% chronic thyroiditis. Neither age nor sex was found to be associated with presence of malignancies in MNGs (p = 0.865 and p = 0.647 respectively). The goiter-size was also not associated with presence of malignancies (p = 0.691). However, the mean duration of thyroid swelling in patients who had malignancy was much higher (8.5 years) than that in patients who did not haveany malignancy (5.7 years) (p = 0.024). Conclusion: The study concluded that a small proportion of long-standing non-toxic MNGs may turn into malignancy. Therefore, routine operative treatment without confirming that the cases are malignant does not seem to be justified. Ibrahim Card Med J 2020; 10 (1&2): 84-88

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Morphological Spectrum of Lesions Seen in Thyroidectomy Specimens At A Tertiary Care Institute

Esculapio ◽

10.51273/esc20.2516314 ◽

2020 ◽

Vol 16 (03, july 2020-Septmber 2020) ◽

Author(s):

Iram Nadeem ◽

Samra Sameen ◽

Sahar Iqbal ◽

Tazeen Anis

Keyword(s):

Papillary Carcinoma ◽

Tertiary Care ◽

Follicular Adenoma ◽

Follicular Carcinoma ◽

Medullary Carcinoma ◽

Anaplastic Carcinoma ◽

Cell Adenoma ◽

Care Institute ◽

Hyalinizing Trabecular Tumor ◽

Neoplastic Lesions

Objective: To determine the morphological spectrum of thyroid lesions encountered in thyroidectomy specimens at a tertiary care institute. Methods: It was a retrospective study conducted in Pathology Department, Allama Iqbal Medical College, Lahore. A retrospective manual collection of data was done from record registers, for the years 2012 & 2013. Results: A total of 307 cases were retrieved with age range of 16-70 years. Amongst them, 47 were males and 260 were females. Non neoplastic conditions outnumbered the neoplastic lesions as 229(75%) cases were of colloid goiter. Hashimoto thyroiditis was present in 12(3.9%) specimens and associated hyperplastic changes were seen in 15(4.9%) cases. There were 19(6.2%) cases of papillary carcinoma, 3(0.9%) cases of follicular carcinoma, 3(0.9%) cases of medullary carcinoma, 1(0.3 %) case of insular carcinoma and 2(0.6%) anaplastic carcinoma. Papillary microcarcinoma was seen in 4(1.3 %) cases and medullary microcarcinoma in 1(0.3%) case. Follicular adenoma comprised 29(9.4%) cases and Hurthle cell adenoma 3(0.9%) cases. Study data also showed 1(0.3%) rare case of hyalinizing trabecular tumor. Conclusion: Non neoplastic thyroid diseases are more common as compared to neoplastic lesions. Papillary carcinoma is most common thyroid malignancy encountered in our setting. Key Words: Thyroidectomy, Colloid goiter, papillary carcinoma

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Histomorphologic spectrum of thyroid lesions in surgically treated thyroid specimens

BIRDEM Medical Journal ◽

10.3329/birdem.v10i1.44761 ◽

2019 ◽

Vol 10 (1) ◽

pp. 54-59

Author(s):

Wasim Selimul Haque ◽

Shamoli Yasmin ◽

SK Md Jaynul Islam ◽

Susane Giti

Keyword(s):

Thyroid Gland ◽

Papillary Carcinoma ◽

Follicular Adenoma ◽

Nodular Goiter ◽

Follicular Carcinoma ◽

Anaplastic Carcinoma ◽

Malignant Neoplasms ◽

Histopathological Diagnosis ◽

Thyroid Lesion ◽

Thyroid Lesions

Background: Diseases involving thyroid gland are myriad- they span from functional to goiterous which again can be non-neoplastic or neoplastic. The pattern and prevalence of these disorders depend on various factors like age, sex, ethnicity and geographic location of residence. The aim of the present study was to determine the pattern of thyroid lesions in surgically resected thyroid specimens. Methods: This retrospective study was conducted at Department of Histopathology ofArmed Forces Institute of Pathology (AFIP), Dhaka, Bangladesh. All thyroidectomy specimens received in the Department of Histopathology over the period from 1st January 2018 to 30th June 2019 were included in the study. Data including age, sex and histopathological diagnosis were collected from the records and histopathology slides of all cases were reviewed to verify diagnosis. Data were then analyzed by standard statistical methods. Results: A total of 377 specimens were collected, 301 specimens were from females and 76 from males (female to male ratio 4.01:1). The age ranged from 13 years to 82 years (mean 38.44±12.89 years). Nodular goiter (274, 72.62%) was the commonest thyroid lesion; other benign lesions included follicular adenoma (18) and Hashimoto thyroiditis (17). Overall malignancy was 18.03% (68). Papillary carcinoma (61, 89.70%) constituted majority of the malignant neoplasms. Other malignant neoplasms included follicular carcinoma (3 cases including 1 case of Hurthle cell carcinoma), anaplastic carcinoma (2) and medullary carcinoma and non-Hodgkin lymphoma 1 each. Conclusion: Our study revealed that the prevalent form of thyroid diseases is nodular goiter that mostly affects females. Papillary carcinoma is the commonest malignancy of thyroid gland which also predominantly affects females. Birdem Med J 2020; 10(1): 54-59

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Mixed Medullary-Follicular Carcinoma of the Thyroid

Case Reports in Endocrinology ◽

10.1155/2013/571692 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3

Author(s):

Maasumeh Tohidi ◽

Gholamreza Pourbehi ◽

Mohammad Bahmanyar ◽

Seyed Sajjad Eghbali ◽

Mohammadreza Kalantar Hormozi ◽

...

Keyword(s):

Thyroid Carcinoma ◽

Fine Needle Aspiration ◽

Follicular Thyroid Carcinoma ◽

Histopathological Examination ◽

Follicular Carcinoma ◽

Needle Aspiration ◽

Anaplastic Carcinoma ◽

Palpable Mass ◽

Serum Calcitonin ◽

Fine Needle

Introduction. Mixed medullary-follicular thyroid carcinoma is an uncommon tumor that consists of both follicular and parafollicular cells.Case. We report a 43-year-old woman with a palpable mass in the right side of the neck. Fine needle aspiration suggested a diagnosis of high grade anaplastic carcinoma that has been associated with papillary features. Total thyroidectomy was done in which histopathological examination showed diagnosis of medullary carcinoma. Immunohistochemical staining was positive for chromogranin, calcitonin, and thyroglobulin in tumoral cells.Conclusion. Mixed medullary-follicular thyroid carcinoma is a rare tumor. Diagnosis of these tumors with fine needle aspiration is very difficult and may lead to misdiagnosis. It is necessary to correlate the cytological finding with serum calcitonin and thyroglobulin. Also immunostaining for calcitonin and thyroglobulin confirms diagnosis.

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Guideline for radioiodine therapy for benign thyroid diseases (version 3)

Nuklearmedizin ◽

10.1055/s-0038-1623919 ◽

2004 ◽

Vol 43 (06) ◽

pp. 217-220 ◽

Cited By ~ 8

Author(s):

J. Dressler ◽

F. Grünwald ◽

B. Leisner ◽

E. Moser ◽

Chr. Reiners ◽

...

Keyword(s):

Radioiodine Therapy ◽

Thyroid Volume ◽

Thyroid Diseases ◽

Antithyroid Drugs ◽

Graves Disease ◽

Co Morbidity ◽

History Of ◽

Individual Decisions ◽

Prophylactic Use ◽

Benign Thyroid

SummaryThe version 3 of the guideline for radioiodine therapy for benign thyroid diseases presents first of all a revision of the version 2. The chapter indication for radioiodine therapy, surgical treatment or antithyroid drugs bases on an interdisciplinary consensus. The manifold criteria for decision making consider the entity of thyroid disease (autonomy, Graves’ disease, goitre, goitre recurrence), the thyroid volume, suspicion of malignancy, cystic nodules, risk of surgery and co-morbidity, history of subtotal thyroidectomy, persistent or recurrent thyrotoxicosis caused by Graves’ disease including known risk factors for relapse, compression of the trachea caused by goitre, requirement of direct therapeutic effect as well as the patient’s preference. Because often some of these criteria are relevant, the guideline offers the necessary flexibility for individual decisions. Further topics are patients’ preparation, counseling, dosage concepts, procedural details, results, side effects and follow-up care. The prophylactic use of glucocorticoids during radioiodine therapy in patients without preexisting ophthalmopathy as well as dosage and duration of glucocorticoid medication in patients with preexisting ophthalmopathy need to be clarified in further studies. The pragmatic recommendations for the combined use of radioiodine and glucocorticoids remained unchanged in the 3rd version.

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Impact of the serum thyroglobulin concentration on the diagnostics of benign and malignant thyroid diseases

Nuklearmedizin ◽

10.1055/s-0038-1632259 ◽

2000 ◽

Vol 39 (05) ◽

pp. 133-138 ◽

Cited By ~ 4

Author(s):

W. Dembowski ◽

H.-J. Schroth ◽

K. Klinger ◽

Th. Rink

Keyword(s):

Hashimoto’S Thyroiditis ◽

Thyroid Volume ◽

Nodular Goiter ◽

Thyroid Diseases ◽

Hashimoto's Thyroiditis ◽

Graves Disease ◽

Normal Range ◽

Serum Thyroglobulin ◽

Diffuse Goiter ◽

Hyperthyroid Patients

Summary Aim of this study is to evaluate new and controversially discussed indications for determining the thyroglobulin (Tg) level in different thyroid diseases to support routine diagnostics. Methods: The following groups were included: 250 healthy subjects without goiter, 50 persons with diffuse goiter, 161 patients with multinodular goiter devoid of functional disorder (108 of them underwent surgery, in 17 cases carcinomas were detected), 60 hyperthyroid patients with autonomously functioning nodular goiter, 150 patients with Hashimoto’s thyroiditis and 30 hyperthyroid patients with Graves’ disease. Results: The upper limit of the normal range of the Tg level was calculated as 30 ng Tg/ml. The evaluation of the collective with diffuse goiter showed that the figure of the Tg level can be expected in a similar magnitude as the thyroid volume in milliliters. Nodular tissue led to far higher Tg values then presumed when considering the respective thyroid volume, with a rather high variance. A formula for a rough prediction of the Tg levels in nodular goiters is described. In ten out of 17 cases with thyroid carcinoma, the Tg was lower than estimated with thyroid and nodular volumes, but two patients showed a Tg exceeding 1000 ng/ml. The collective with functional autonomy had a significantly higher average Tg level than a matched euthyroid group being under suppressive levothyroxine substitution. However, due to the high variance of the Tg values, the autonomy could not consistently be predicted with the Tg level in individual cases. The patients with Hashimoto’s thyroiditis showed slightly decreased Tg levels. In Graves’ disease, a significantly higher average Tg level was observed compared with a matched group with diffuse goiter, but 47% of all Tg values were still in the normal range (< 30 ng/ml). Conclusion: Elevated Tg levels indicate a high probability of thyroid diseases, such as malignancy, autonomy or Graves’ disease. However, as low Tg concentrations cannot exclude the respective disorder, a routine Tg determination seems not to be justified in benign thyroid diseases.

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Defect of a subpopulation of natural killer immune cells in Graves’ disease and Hashimoto’s thyroiditis: normalizing effect of dehydroepiandrosterone sulfate

Acta Endocrinologica ◽

10.1530/eje.1.01906 ◽

2005 ◽

Vol 152 (5) ◽

pp. 703-712 ◽

Cited By ~ 15

Author(s):

Sebastiano Bruno Solerte ◽

Sara Precerutti ◽

Carmine Gazzaruso ◽

Eleonora Locatelli ◽

Mauro Zamboni ◽

...

Keyword(s):

Nk Cells ◽

Hashimoto’S Thyroiditis ◽

Nk Cell ◽

Secretory Activity ◽

Thyroid Diseases ◽

Hashimoto's Thyroiditis ◽

Graves Disease ◽

Autoimmune Thyroid Diseases ◽

Autoimmune Thyroid ◽

Tnf Α

Background: The study of the natural killer (NK) immune compartment could provide important findings to help in the understanding of some of the pathogenetic mechanisms related to autoimmune thyroid diseases (Graves’ disease (GD) and Hashimoto’s thyroiditis (HT)). Within this context, it was suggested that alterations in NK cell cytotoxicity (NKCC) and NK production of cytokines might occur in subjects with GD and HT, whereas the normalization of NK functions could potentially contribute to the prevention of the onset or the progression of both diseases. Objective: Due to the hypothesis of alterations in NK in autoimmune thyroid diseases, we were interested to evaluate NKCC in GD and HT patients and to modulate NK function and secretory activity with cytokines and dehydroepiandrosterone sulfate (DHEAS) in an attempt to normalize NK cell defect. Design: We studied 13 patients with recent onset Graves’ disease, 11 patients with Hashimoto’s thyroiditis at first diagnosis and 15 age-matched healthy subjects. Methods: NK cells were concentrated at a density of 7.75 × 106 cells/ml by negative immunomagnetic cell separation and validated by FACScan as CD16 + /CD56 + cells. NK cells were incubated with interleukin-2 (IL-2) and interferon-β (IFN-β) and co-incubated with DHEAS at different molar concentrations for measuring NKCC and the secretory pattern of tumor necrosis factor-α (TNF-α) from NK cells. Results: Lower spontaneous, IL-2- and IFN-β-modulated NKCC was demonstrated in GD and HT patients compared with healthy subjects (P < 0.001). A decrease in spontaneous and IL-2-modulated TNF-α release from NK cells was also found in both groups of patients (P < 0.001). The co-incubation of NK cells with IL-2/IFN-β + DHEAS at different molar concentrations (from 10−8 to 10−5 M/ml/NK cells) promptly normalized NKCC and TNF-α secretion in GD and HT patients. Conclusions: A functional defect of a subpopulation of NK immune cells, involving both NKCC and the secretory activity, was demonstrated in newly-diagnosed GD and HT patients. This defect can be reversed by a dose-dependent treatment with DHEAS. The impairment of NK cell activity in autoimmune thyroid diseases could potentially determine a critical expansion of T/B-cell immune compartments leading to the generation of autoantibodies and to the pathogenesis of thyroid autoimmunity.

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