Practical Pathology of Thyroid
Case 1 A 50 yr old lady presents with a mass in anterior neck Slowly growing since 10 yr ago Soft and nodular, moves with swallowing No cervical LAD felt Rest of PE is normal
Work - up Thyroid hormone profile ordered : TSH : 3.5 IU/L (0.5 – 5 IU/L) T4 : 6.2 µg/dl (4.5 – 12 µg/dL) T3 : 134 ng/ dl (100 – 220 ng/dL) T3RU : 24 % ( %)
Thyroid scan ordered
Work-up Thyroid scan ordered
Thyroid scan
Thyroid FNA performed :
Thyroid FNA
Diagnosis: Multinodular goiter Patient underwent surgery :
Microscopic images
Final diagnosis : Multinodular Goiter
Case 2 A 45 yr old lady presents with a lump in anterior part of neck at right thyroid lobe Slowly growing since 4 months ago The mass is firm and indiscrete, and moves with swallowing Other PEs are normal No cervical LAD is present She has Hx of Raynaud’s phenomenon
Thyroid hormone profile ordered : TSH: 7.2 IU/L (0.5 – 5 IU/L) T4: 4.1 µg/dl (4.5 – 12 µg/dL) T3: 105 ng/dl (100 – 220 ng/dL) 7.2
Thyroid FNA performed :
Microscopic features
Final diagnosis: Hashimoto’s Thyroiditis
Case 3 A 33 yr old man presents with firmness of his left thyroid lobe and a nodule in left cervical chain growing since 2 wks ago The latter nodule is soft The left thyroid is firm Other exams are normal
Next work-up step : Thyroid FNA
Diagnosis : Papillary carcinoma of thyroid with cervical lymph node metastasis Patient underwent total thyroidectomy and left cervical LN resection
Gross and microscopic features
microscopic features
Papillae, psamomma bodies
Final dagnosis: Papillary Carcinoma of Thyroid