Difference between revisions of "Hashimoto's thyroiditis"

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{{ Infobox diagnosis
{{ Infobox diagnosis
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| Image      = Hashimoto thyroiditis -- intermed mag.jpg
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| Caption    = Hashimoto thyroiditis. [[H&E stain]].
| Synonyms  =
| Synonyms  =
| Micro      = polymorphous lymphoplasmacytic infiltrate with germinal centres, +/-nuclear clearing common, +/-oncocytic metaplasia
| Micro      = polymorphous lymphoplasmacytic infiltrate with germinal centres, +/-nuclear clearing common, +/-oncocytic metaplasia

Revision as of 04:17, 12 December 2015

Hashimoto's thyroiditis
Diagnosis in short

Hashimoto 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]

Microscopic

Features:

  • Lymphocytic infiltrate - key feature.
  • Nuclear clearing common.
  • Polymorphous lymphoplasmacytic infiltrate with germinal centres.[4]
  • +/-Oncocytic metaplasia.

Notes:

  • Histologically often not possible to separate from "non-specific" thyroiditis.[5]

DDx:

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. Lefkowitch, Jay H. (2006). Anatomic Pathology Board Review (1st ed.). Saunders. pp. 672. ISBN 978-1416025887.
  5. 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.