Practical pathology of thyroid

Case 1 A 50 yr old lady presents with a mass in anterior neck, slowly growing since 10 yr ago. It is soft and nodular, and moves with swallowing. No cervical LAD felt. Rest of PE is normal.

Work - up TSH : 3.5 IU/L ( 0.5 – 5 IU/L ) Thyroid hormone profile ordered : TSH : 3.5 IU/L ( 0.5 – 5 IU/L ) T4 : 6.2 micgr/dl ( 4.5 – 12 micgr/dl ) T3 : 134 ng/ dl ( 100 – 220 ng/dl ) T3RU : 24 % ( 20 - 35 % )

Work-up Thyroid scan ordered

Thyroid scan

Thyroid FNA performed :

Clin. Diag : Multinodular goiter Patient underwent surgery :

Microscopic images

Microscopic images

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 physical exams are normal. No cervical LAD is present. She has Hx. Of Raynaud’s phenomenon.

Thyroid hormone profile ordered : TSH : 7.2 IU/L T4 : 4.1 micgr/dl T3 : 105 ng/dl

Thyroid FNA performed :

Diagnosis : Hashimoto’s thyroiditis

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, but the left thyroid is firm. Other exams are normal.

Next work-up step :

Diagnosis : Papillary carcinoma of thyroid with cervical lymph node metastasis Patient underwent total thyroidectomy and left cervical LN resection

Papillary CA of thyroid