Hashimoto's thyroiditis

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Hashimoto's thyroiditis, also Hashimoto's disease, is an inflammatory (autoimmune disorder) of the thyroid gland that causes hypothyroidism.

Hashimoto's thyroiditis
Diagnosis in short
Template:Px
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

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]

Possibly associated pathology:

Microscopic

Features:

  • Lymphocytic infiltrate - key feature.
  • Nuclear clearing common.
  • Polymorphous lymphoplasmacytic infiltrate with germinal centres.[6]
  • +/-Oncocytic metaplasia.

Notes:

  • Histologically often not possible to separate from "non-specific" thyroiditis.[7]

DDx:

Images

  • Hashimoto thyroiditis -- very low mag.jpg

    HT - very low mag. (WC)

  • Hashimoto thyroiditis -- low mag.jpg

    HT - low mag. (WC)

  • Hashimoto thyroiditis -- intermed mag.jpg

    HT - intermed. mag. (WC)

  • Hashimoto thyroiditis -- high mag.jpg

    HT - high mag. (WC)

  • Hashimoto thyroiditis - alt -- very low mag.jpg

    HT - very low mag. (WC)

  • Hashimoto thyroiditis - alt -- intermed mag.jpg

    HT - intermed. mag. (WC)

IHC

  • Panel to exclude lymphoma may be required, e.g. CD3, CD20, CD10, BCL6, BCL2, kappa, lambda.

Molecular

Sign out

Total Thyroid, Thyroidectomy: 
- Lymphocytic thyroiditis compatible with clinical history of Hashimoto's thyroiditis. 
- NEGATIVE for malignancy.

See also

References

  1. ↑ 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.
  2. ↑ URL: http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/84382. Accessed on: 15 October 2015.
  3. ↑ Ohye, H.; Fukata, S.; Hirokawa, M. (Nov 2007). "[Malignant lymphoma of the thyroid].". Nihon Rinsho 65 (11): 2092-8. PMID 18018576.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ Lefkowitch, Jay H. (2006). Anatomic Pathology Board Review (1st ed.). Saunders. pp. 672. ISBN 978-1416025887.
  7. ↑ 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.
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