Chronic Lymphocytic (Hashimoto's) Thyroiditis in Kuwait Diagnosed by Fine Needle Aspirates

Abstract

A retrospective analysis of 4185 consecutive fine needle aspirates (FNA) of the thyroid over an eight year period at a teaching hospital in Kuwait revealed that 14.3% of all the aspirates had features of chronic lymphocytic (Hashimoto's) thyroiditis (HT). The proportion of patients with HT showed a slight increase in the last two years but the pattern of clinical presentation has remained unchanged. Hashimoto's thyroiditis was most prevalent in the age group from 16 to 35 and the majority of young patients with Hashimoto's thyroiditis presented with diffuse goiter (DG) whereas multinodular goiter (MNG) and solitary thyroid nodule (STN) were more common in the older age group. Of patients who presented with STN, the most common abnormality on thyroid scan was a "cold nodule". Functional disturbances (hypo and hyperthyroidism) occurred less frequently in patients presenting as STN than in patients presenting with DG or MNG. We conclude that FNA is indicated in all young patients with diffuse goiter in this region in order to facilitate early detection and initiation of suppressive thyroxine therapy. Further, when young patients present with "cold" solitary nodules of the thyroid, HT is a more common cause than a thyroid carcinoma in Kuwait. Ann Saudi Med 1995;15(4) It has been our impression over the last two years that in Kuwait, chronic lymphocytic (Hashimoto's) thyroiditis (HT) presents at an earlier age and that a relatively greater proportion of patients with this disorder present as solitary nodules. In order to verify these impressions, we performed a retrospective analysis of all the fine needle aspirate (FNA) reports and the relevant clinical information from January 1986 to December 1993. We felt that such an analysis would give us information on the spectrum of HT in Kuwait, whether it differs from the spectrum of HT in other parts of the world and whether it has changed over the years. MethodsMubarak Al Kabeer Hospital is a tertiary care university teaching hospital in Kuwait and one of the major centers for fine needle aspiration cytology in this country. Information on all thyroid FNAs performed in this hospital was available from January 1986. The relevant clinical information available in the request forms and in the cytology registry was collected and analyzed. On the basis of clinical examination, patients were diagnosed to have a) diffuse goiter; b) multinodular goiter; and c) solitarythyroid nodule. Fine needle aspirates on these patients were diagnosed as follicular neoplasm, carcinoma, Hashimoto's thyroiditis or other benign lesions of the thyroid. When the FNA smears showed moderate to abundant lymphoid infiltrate with a variable degree of Hurthle cell metaplasia and follicular destruction, the diagnosis of Hashimoto's thyroiditis was suggested. The diagnosis of a follicular neoplasm was made when numerous follicular cells were seen in a microfollicular pattern with scant colloid. FNA smears were categorized as carcinoma when cytologic features suggestive of a papillary or undifferentiated c...

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