Lymphocytic thyroiditis – is cytological grading significant? A correlation of grades with clinical, biochemical, ultrasonographic and radionuclide parameters

BackgroundClinical, biochemical, ultrasonographic, radionuclide and cytomorphological observations in Lymphocytic thyroiditis (LT), to define the cytological grading criteria on smears and correlation of grades with above parameters. MethodsThis prospective study was conducted on 76 patients attending the Fine needle aspiration cytology clinic of a tertiary care institute in North India. The various parameters like patients’ clinical presentation, thyroid antimicrosomal antibodies, hormonal profiles, radionuclide thyroid scan and thyroid ultrasound were studied. Fine needle aspiration of thyroid gland and grading of thyroiditis was done on smears. The grades were correlated with above parameters and the correlation indices were evaluated statistically. ResultsMost of the patients were females (70, 92.11%) who presented with a diffuse goiter (68, 89.47%). Hypothyroid features (56, 73.68%) and elevated TSH (75, 98.68%) were common, but radioiodide uptake was low or normal in majority of patients. Thyroid antimicrosomal antibody was elevated in 46/70 (65.71%) patients. Cytomorphology in fine needle aspirates was diagnostic of lymphocytic thyroiditis in 75 (98.68%) patients. Most of them had grade I/II disease by cytology. No correlation was observed between grades of cytomorphology and clinical, biochemical, ultrasonographic and radionuclide parameters. ConclusionDespite the availability of several tests for diagnosis of LT, FNAC remains the gold standard. The grades of thyroiditis at cytology however do not correlate with clinical, biochemical, radionuclide and ultrasonographic parameters.

Interaction of antibodies from the sera of autoimmune patients thyroidopathies with isolated diffuse cells toxic euthyroid nodular goiter.

Blood sera of 46 patients with diffuse toxic goiter (DTG) and of 48 ones with Hashimotos thyroiditis (HT) were tested for antibodiescomplement-mediated cytotoxicity carriers (ACMMC). ACMCC targets were isolated DTG cells and cells of euthyroid nodular goiter (ENG) perinodular tissue. Antimicrosomal antibodies were assayed in the sera by indirect immunofluorescence and antibodies to all thyrocyte surface antigens isolated from both tissue samples were determined by solid-phase enzyme immunoassay. When DTG cells were targets, DTG patients' sera detected ACMCC in 36 % of cases and HT patients sera in 73% of cases (p0.001). In ENG cells the sera of patients of both groups detected ACMCC equally frequently (in more than 70% of cases). Of the 27 DTG patients sera tested with both tissues app. roximately a half detected ACMCC in only ENG tissue. There was no difference in HT patients sera effects on ACMCC detection in both tissue samples. This has brought the authors to a conclusion about DTG cells deficiency for ACMCC mediating antigens. Moreover, DTG cells bound much less antibodies from sera of patients with autoimmune thyropathies, than ENG cells (p0.001), this confirming a deficiency of surface antigen on DTG cells. No correlation between the presence in the sera of antimicrosomal cells and of ACMCC was detected. A conclusion has been made about heterogeneity of antimicrosomal antibody population and about the presence of ACMCC in blood sera of patients with autoimmune thyropathies, these antibodies not belonging to antimicrosomal ones. ACMCC also may be heterogenous and differ in DTG and HT patients.

Recovery of thyroid function with a decreased titre of antimicrosomal antibody in a hypothyroid man with Hashimoto's thyroiditis

A 36 year old man with a diffuse goitre, signs of mild hypothyroidism, strikingly low levels of T4 (0.9 μg/dl) and T3 (24 ng/dl), elevated TSH (140 μU/ml) and elevated microsomal haemagglutination antibody (MCHA, 1:409 600), subsequently became non-goitrous and euthyroid with a decreased titre of antimicrosomal antibody without any medication. At the time of surgical biopsy, serum levels of T4 and T3 had risen to the normal range (4.6 μg/dl and 73 ng/dl, respectively), serum TSH had decreased to 30 μU/ml and the titre of MCHA to 1:25 600. Thyroid specimens showed Hashimoto's thyroiditis. The activity of thyroid peroxidase (TPO) was normal. The latest examination, 1 year and 3 months after initial evaluation, showed that the patient remained euthyroid with no goitre, that serum thyroid hormones were within the normal range (T4 7.7 μg/dl and T3 97 ng/dl), and that TSH was not detectable. The titre of MCHA decreased strikingly to 1:400.