Pathology of the Thyroid Gland
Zubair W. Baloch and Virginia A. LiVolsi
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A 28 year old woman presented with a goiter and symptoms ofthyrotoxicosis. Thyroid function tests supported the clinical findings: elevated T4, markedly suppressed TSH. She refused radioiodine treatment and was allergic to antithyroid drugs. After pretreatment with propanolol and potassium iodide, she underwent subtotal thyroidectomy.
The gross specimen was a diffusely enlarged thyroid weighing 140 grams; no nodules were present.
A 76 year old woman presented to her physician with weakness and feeling tired. On examination, a small goiter (estimated weight: 50 grams) was noted. Multiple nodules (up to 1 cm) were noted bilaterally. Thyroid function tests showed decreased T4, elevated TSH and presence of antithyroid antibodies (1: 600).
FNA of two of the larger nodules showed thyroiditis and atypical nuclei were seen raising the possibility of neoplasm.
Thyroid lobectomy (side with the two largest nodules) was undertaken. The gross specimen showed a lobulated tan tissue with indistinct nodularity.
This 46 year old man presented with a 2.5 cm left thyroid nodule. He was clinically and biochemically euthyroid.
Ultrasound guided FNA of the nodule showed "follicular neoplasm" and thyroid lobectomy was performed.
Grossly, the lobe showed an encapsulated tan nodule; a small "gray area" about 3 mm in size was seen above the main lesion. Your slide is from the latter nodule.
A 24 year old woman was noted to have a 2 cm thyroid nodule during a prenatal physical examination. She was euthyroid clinically and by laboratory evaluation.
FNA was performed and a diagnosis of "follicular neoplasm" was rendered. During the second trimester of her pregnancy, thyroid lobectomy was performed.
Grossly the nodule was 2 cm and appeared circumscribed.
This 69 year old woman presented with hoarseness and a right sided neck mass, measuring 5 cm.
FNA was performed and a diagnosis of "papillary carcinoma" was rendered. Total thyroidectomy and neck node dissection were carried out.
A 47 year old woman presented with a 7 cm left neck mass with associated cervical lymphadenopathy.
After FNA diagnosis of "malignant neoplasm', thyroidectomy was performed.
Grossly, the tumor was poorly circumscribed, appeared to extend beyond the thyroid itself and showed foci of necrosis.
A 58 year old man complained of diarrhea. Evaluation of the GI tract was negative, but on examination of his neck a 2.5 cm thyroid mass was found. Thyroid function tests were normal, serum calcitonin was 28,000 units. Family history was negative for thyroid or other endocrine disease.
After FNA confirmed the suspected clinical diagnosis, total thyroidectomy and node dissection including central node removal were performed.
Grossly, the tumor was tan-yellow and circumscribed. The surrounding thyroid appeared normal.