Difference between revisions of "Hashimoto's thyroiditis"
Jump to navigation
Jump to search
| (13 intermediate revisions by the same user not shown) | |||
| Line 1: | Line 1: | ||
'''Hashimoto's thyroiditis''', also '''Hashimoto's disease''', is an autoimmune disorder that causes hypothyroidism. | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | |||
| Image = Hashimoto thyroiditis -- intermed mag.jpg | |||
| Width = | |||
| Caption = Lymphocytic thyroiditis with serologic evidence of Hashimoto's thyroiditis. [[H&E stain]]. | |||
| Synonyms = | |||
| Micro = polymorphous lymphoplasmacytic infiltrate with germinal centres, +/-nuclear clearing common, +/-oncocytic metaplasia | |||
| Subtypes = | |||
| LMDDx = [[lymphocytic thyroiditis]] (no serologic evidence of Hashimoto), [[papillary thyroid carcinoma]], [[MALT lymphoma]], [[Diffuse large B cell lymphoma]], [[Hürthle cell neoplasm]] | |||
| Stains = | |||
| IHC = CD3, CD20, CD10, BCL6, BCL2, kappa, lambda - to demonstrated mixed population of lymphocytes | |||
| EM = | |||
| Molecular = B-Cell clonality testing negative | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Staging = | |||
| Site = [[thyroid gland]] | |||
| Assdx = increased risk of [[lymphoma]] | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = uncommon | |||
| Bloodwork = antimicrosomal (antithyroid peroxidase) positive | |||
| Rads = | |||
| Endoscopy = | |||
| Prognosis = benign | |||
| Other = | |||
| ClinDDx = | |||
| Tx = | |||
}} | |||
'''Hashimoto's thyroiditis''', also '''Hashimoto's disease''', is an inflammatory (autoimmune disorder) of the [[thyroid gland]] that causes hypothyroidism. | |||
==General== | ==General== | ||
| Line 19: | Line 51: | ||
**[[MALT lymphoma]]. | **[[MALT lymphoma]]. | ||
**[[Diffuse large B cell lymphoma]] (DLBCL). | **[[Diffuse large B cell lymphoma]] (DLBCL). | ||
===Hashimoto's thyroiditis and papillary thyroid carcinoma=== | |||
*Association between Hashimoto's and papillary thyroid carcinoma considered controversial - literature divided.<ref name=pmid25419066>{{Cite journal | last1 = Anand | first1 = A. | last2 = Singh | first2 = KR. | last3 = Kushwaha | first3 = JK. | last4 = Hussain | first4 = N. | last5 = Sonkar | first5 = AA. | title = Papillary Thyroid Cancer and Hashimoto's Thyroiditis: An Association Less Understood. | journal = Indian J Surg Oncol | volume = 5 | issue = 3 | pages = 199-204 | month = Sep | year = 2014 | doi = 10.1007/s13193-014-0325-4 | PMID = 25419066 }}</ref> | |||
**Jankovic ''et al.'' dispute that there is an association.<ref name=pmid23293329>{{Cite journal | last1 = Jankovic | first1 = B. | last2 = Le | first2 = KT. | last3 = Hershman | first3 = JM. | title = Clinical Review: Hashimoto's thyroiditis and papillary thyroid carcinoma: is there a correlation? | journal = J Clin Endocrinol Metab | volume = 98 | issue = 2 | pages = 474-82 | month = Feb | year = 2013 | doi = 10.1210/jc.2012-2978 | PMID = 23293329 }}</ref> | |||
**Zhang ''et al.'' show a correlation.<ref name=pmid24619663>{{Cite journal | last1 = Zhang | first1 = Y. | last2 = Dai | first2 = J. | last3 = Wu | first3 = T. | last4 = Yang | first4 = N. | last5 = Yin | first5 = Z. | title = The study of the coexistence of Hashimoto's thyroiditis with papillary thyroid carcinoma. | journal = J Cancer Res Clin Oncol | volume = 140 | issue = 6 | pages = 1021-6 | month = Jun | year = 2014 | doi = 10.1007/s00432-014-1629-z | PMID = 24619663 }}</ref> | |||
==Microscopic== | ==Microscopic== | ||
| Line 36: | Line 73: | ||
*[[MALT lymphoma]]. | *[[MALT lymphoma]]. | ||
*[[Diffuse large B cell lymphoma]]. | *[[Diffuse large B cell lymphoma]]. | ||
*[[Hürthle cell neoplasm]]. | |||
===Images=== | |||
<gallery> | |||
Image: Hashimoto thyroiditis -- very low mag.jpg | HT - very low mag. (WC) | |||
Image: Hashimoto thyroiditis -- low mag.jpg | HT - low mag. (WC) | |||
Image: Hashimoto thyroiditis -- intermed mag.jpg | HT - intermed. mag. (WC) | |||
Image: Hashimoto thyroiditis -- high mag.jpg | HT - high mag. (WC) | |||
Image: Hashimoto thyroiditis - alt -- very low mag.jpg | HT - very low mag. (WC) | |||
Image: Hashimoto thyroiditis - alt -- intermed mag.jpg | HT - intermed. mag. (WC) | |||
</gallery> | |||
==IHC== | ==IHC== | ||
| Line 52: | Line 101: | ||
==See also== | ==See also== | ||
*[[Thyroid gland]]. | *[[Thyroid gland]]. | ||
*[[Graves' disease]]. | |||
==References== | ==References== | ||
Latest revision as of 21:29, 13 September 2016
| Hashimoto's thyroiditis | |
|---|---|
| Diagnosis in short | |
 Lymphocytic thyroiditis with serologic evidence of Hashimoto's thyroiditis. H&E stain. | |
|
| |
| LM | polymorphous lymphoplasmacytic infiltrate with germinal centres, +/-nuclear clearing common, +/-oncocytic metaplasia |
| LM DDx | lymphocytic thyroiditis (no serologic evidence of Hashimoto), papillary thyroid carcinoma, MALT lymphoma, Diffuse large B cell lymphoma, Hürthle cell neoplasm |
| IHC | CD3, CD20, CD10, BCL6, BCL2, kappa, lambda - to demonstrated mixed population of lymphocytes |
| Molecular | B-Cell clonality testing negative |
| Site | thyroid gland |
|
| |
| Associated Dx | increased risk of lymphoma |
| Prevalence | uncommon |
| Blood work | antimicrosomal (antithyroid peroxidase) positive |
| Prognosis | benign |
Hashimoto's thyroiditis, also Hashimoto's disease, is an inflammatory (autoimmune disorder) of the thyroid gland that causes hypothyroidism.
General
- This is a clinical diagnosis.
- The histomorphologic findings, generally, are not diagnostic.
Etiology:
- Autoimmune disease leading to hypothyroidism.
- Often genetic/part of a syndrome.
Clinical
Serology:[1]
- Antimicrosomal (antithyroid peroxidase) +ve.
- Antithyroglobulin +ve.
- Normal: <4.0 IU/mL.[2]
Associated pathology:[1]
- Increased risk of B-cell lymphoma; these are classically:[3]
- MALT lymphoma.
- Diffuse large B cell lymphoma (DLBCL).
Hashimoto's thyroiditis and papillary thyroid carcinoma
- Association between Hashimoto's and papillary thyroid carcinoma considered controversial - literature divided.[4]
Microscopic
Features:
- Lymphocytic infiltrate - key feature.
- Nuclear clearing common.
- May confuse with papillary thyroid carcinoma.
- Polymorphous lymphoplasmacytic infiltrate with germinal centres.[7]
- +/-Oncocytic metaplasia.
Notes:
- Histologically often not possible to separate from "non-specific" thyroiditis.[8]
DDx:
- Lymphocytic thyroiditis.
- Papillary thyroid carcinoma.
- MALT lymphoma.
- Diffuse large B cell lymphoma.
- Hürthle cell neoplasm.
Images
HT - very low mag. (WC)
HT - low mag. (WC)
HT - intermed. mag. (WC)
HT - high mag. (WC)
HT - very low mag. (WC)
HT - intermed. mag. (WC)
IHC
- Panel to exclude lymphoma may be required, e.g. CD3, CD20, CD10, BCL6, BCL2, kappa, lambda.
Molecular
- Occasionally done to exclude lymphoma - see MALT lymphoma and DLBCL.
Sign out
Total Thyroid, Thyroidectomy: - Lymphocytic thyroiditis compatible with clinical history of Hashimoto's thyroiditis. - NEGATIVE for malignancy.
See also
References
- ↑ 1.0 1.1 Poropatich C, Marcus D, Oertel YC (1994). "Hashimoto's thyroiditis: fine-needle aspirations of 50 asymptomatic cases". Diagn. Cytopathol. 11 (2): 141–5. PMID 7813361. http://www3.interscience.wiley.com/journal/112701408/abstract?CRETRY=1&SRETRY=0.
- ↑ URL: http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/84382. Accessed on: 15 October 2015.
- ↑ Ohye, H.; Fukata, S.; Hirokawa, M. (Nov 2007). "[Malignant lymphoma of the thyroid].". Nihon Rinsho 65 (11): 2092-8. PMID 18018576.
- ↑ Anand, A.; Singh, KR.; Kushwaha, JK.; Hussain, N.; Sonkar, AA. (Sep 2014). "Papillary Thyroid Cancer and Hashimoto's Thyroiditis: An Association Less Understood.". Indian J Surg Oncol 5 (3): 199-204. doi:10.1007/s13193-014-0325-4. PMID 25419066.
- ↑ Jankovic, B.; Le, KT.; Hershman, JM. (Feb 2013). "Clinical Review: Hashimoto's thyroiditis and papillary thyroid carcinoma: is there a correlation?". J Clin Endocrinol Metab 98 (2): 474-82. doi:10.1210/jc.2012-2978. PMID 23293329.
- ↑ Zhang, Y.; Dai, J.; Wu, T.; Yang, N.; Yin, Z. (Jun 2014). "The study of the coexistence of Hashimoto's thyroiditis with papillary thyroid carcinoma.". J Cancer Res Clin Oncol 140 (6): 1021-6. doi:10.1007/s00432-014-1629-z. PMID 24619663.
- ↑ Lefkowitch, Jay H. (2006). Anatomic Pathology Board Review (1st ed.). Saunders. pp. 672. ISBN 978-1416025887.
- ↑ Mills, Stacey E; Carter, Darryl; Greenson, Joel K; Oberman, Harold A; Reuter, Victor E (2004). Sternberg's Diagnostic Surgical Pathology (4th ed.). Lippincott Williams & Wilkins. pp. 560. ISBN 978-0781740517.