Non‐toxic Goitre: Diagnostic Role of Aspiration Cytology, Antibodies and Serum Thyrotrophin

Abstract

Fifty cases of bilateral non-toxic goitre, largely unselected, have been studied using fine needle aspiration cytology (without local anaesthesia); four techniques of thyroid antibody tests; serum thyroid biochemistry (including radioimmunoassay of TSH) and clinical evaluation. Autoimmune thyroiditis was found cytologically in 64%; simple colloid goitre in 24%; subacute thyroiditis of de Quervain in 10%. Aspiration cytology was the most sensitive means of detecting autoimmune thyroiditis and subacute thyroiditis. Two antibodies directed against the intra-cellular cytoplasmic antigen--the complement fixation test and an immunofluorescent antibody were of lesser value in detecting autoimmune thyroiditis (80% positivity) though equal to each other. Serum TSH was of some value--being elevated in 63% of cases of autoimmune thyroiditis and in no cases of simple colloid goitre. Two major cytological subtypes of autoimmune thyroiditis have been described--with significant differences in duration of goitre, mode of presentation, frequency of hypothyroidism, and response to thyroxine therapy. The high frequency of autoimmune thyroiditis in this series suggests that endemic goitre is unlikely in Western Australia.

Correlation of number of intrathyroid lymphocytes with antimicrosomal antibody titer in Hashimoto's thyroiditis

“…Lymphocytes were found to be present in all cases but to differ in density. Gutteridge and Orell 16 studied cytological pattern in relation to clinical and immunological findings. These investigators found some relationship to histological types only in florid and classic types.…”

“…1 Estimations of antibody levels and thyroid-stimulating hormone (TSH) provide a diagnosis in 90 -95% of cases at best. 2 Antibodies are positive in only 60 -80% in some series 3 and in a smaller percentage in children and adolescents. Therefore, cytological diagnosis is valuable in these cases.…”

Prevalence and progression of subclinical hypothyroidism in women with type 2 diabetes: the Fremantle Diabetes Study

“…11 The iodine nutritional status of the patients was unknown but iodine deficiency is rare in Western Australia. 13 The present unselected sample represented 65·9% of all 663 type 2 women recruited to the FDS after those participating in a study of genetic haemochromatosis had been excluded. 14…”

Μεταβολες Των Ενδογενων Οπιοειδων Πεπτιδιων Σε Ασθενεις Με Νοσηματα Του Θυρεοειδους

“…Σε ορισμένες μελέτες τα επίπεδα της TSH του πλάσματος βρέθηκαν κατά 42% υψηλότερα από αυτά των φυσιολογικών ατόμων 20 , ενώ σε άλλες δεν διαπιστώθηκε διαφορά στα επίπεδα της TSH μεταξύ των δύο ομάδων 19 . Ασθενείς με μη τοξική βρογχοκήλη και φυσιολογικά επίπεδα TSH του πλάσματος που υποβλήθηκαν σε βιοψία, παρουσίασαν στην πλειονότητα αλλοιώσεις συμβατές με θυρεοειδίτιδα Hashimoto 21 .…”