Hashimoto thyroiditis

Case contributed by Dr Andrew Ryan

Presentation

Initially presented with goitre. Found to have abnormal thyroid hormone profile.

Patient Data

Age: 40 years
Gender: Female
Ultrasound

Selected images through the thyroid gland demonstrate it to be moderately enlarged, especially on the left, somewhat heterogeneous echotexture. In the isthmus a mixed solid cystic lesion without blood flow (Doppler not shown) is also present. 

Images courtesy of Dr Meei Yeung

Pathology

Total thyroidectomy performed

Macroscopic:

Serial transverse sections through right and left lobes and sagittal sections through isthmus (orientation as marked)

  • the gland is enlarged
  • the normal tan, fleshy appearance of thyroid parenchyma (residual parenchyma seen in the left lobe) is now seen as pale and homogeneous (R>L)
  • sonographically-noted isthmic lesion is identified
  • no other suspicious macroscopic lesions

Microscopic:

  • low power: extensive replacement of thyroid parenchyma by diffuse reactive lymphoid infiltrate including activated follicles with germinal centres. There is a zone of residual identifiable parenchyma in the top right corner.
  • high power: sheets of uniform, small, regular lymphocytes surrounding scattered residual follicles (bottom right). 
  • there is gross distortion and replacement of normal thyroid microscopic architecture
  • the engulfed follicular epithelium often shows associated cytological changes including nuclear activation and cytoplasmic oncocytic/Hurtle cell change

The isthmus cystic lesion was benign on histological examination

Case Discussion

This case illustrates the pathological appearances of Hashimoto thyroiditis, with ultrasound correlate. 

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Case information

rID: 17084
Published: 15th Mar 2012
Last edited: 16th Jul 2018
System: Head & Neck
Inclusion in quiz mode: Included

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