The Pathology of Autoimmune Thyroid Disease: A Review

LiVolsi, Virginia A.

doi:10.1089/thy.1994.4.333

Cited by 122 publications

(81 citation statements)

References 101 publications

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“…27,30,31 As a result of the histological similarity, confusion has been noted in the literature regarding Riedel's thyroiditis and fibrous variant of Hashimoto's thyroiditis. 23 Most recently, an association between Riedel's thyroiditis and IgG4-related disease has been described by Dahlgren et al 32 They demonstrated excessive numbers of the IgG4-positive plasma cells in Riedel's thyroiditis samples. This observation would seem to further blur the distinction between the IgG4-related Hashimoto's thyroiditis and Riedel's thyroiditis.…”

Section: Discussionmentioning

confidence: 95%

“…The most widely recognized subgroup is referred to as the fibrous variant of Hashimoto's thyroiditis, which accounts for approximately 10% of the Hashimoto's thyroiditis cases. 23 Katz and Vickery 2 defined this lesion in 1974 and proposed the following diagnostic criteria: (1) a marked fibrous replacement of more than one-third of the thyroid parenchyma and (2) changes typical of Hashimoto's thyroiditis in the remaining tissue. They also demonstrated that fibrous variant of Hashimoto's thyroiditis reveals a series of clinical features that are quite distinct from those of typical Hashimoto's thyroiditis, including a firm goiter (often presenting with a notable recent enlargement), frequent diagnostic confusion with a malignancy, a marked elevation in the tanned red cell titer and thyroglobulin, and thyroid function tests often indicating hypothyroidism.…”

Section: Discussionmentioning

confidence: 99%

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Distinct histopathological features of Hashimoto's thyroiditis with respect to IgG4-related disease

Zhou

Ozaki

et al. 2012

Modern Pathology

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A form of Hashimoto's thyroiditis with lymphoplasmacytic sclerosing changes and increased numbers of IgG4-positive plasma cells has recently been reported in the literature. These histopathological features suggest that this subtype of Hashimoto's thyroiditis may be closely related to IgG4-related disease. Therefore, this unique form of IgG4-related Hashimoto's thyroiditis, which is referred to as IgG4 thyroiditis, has its own clinical, serological, and sonographic features that are distinct from those associated with non-IgG4 thyroiditis. IgG4 thyroiditis shares similarities with the well-known fibrous variant of Hashimoto's thyroiditis; however, the detailed histopathological features of IgG4 thyroiditis have not been well established. Based on immunostaining results, 105 patients with Hashimoto's thyroiditis were divided into an IgG4 thyroiditis group (n ¼ 28) and a non-IgG4 thyroiditis group (n ¼ 77). As in our previous reports, IgG4 thyroiditis was associated with a patient population of a younger age, a lower female-to-male ratio, rapid progression, higher levels of thyroid autoantibodies, subclinical hypothyroidism, and diffuse sonographic echogenicity. Histopathologically, this group revealed severe lymphoplasmacytic infiltration, dense stromal fibrosis, marked follicular cell degeneration, numerous micro-follicles, and notable giant cell/histiocyte infiltration. Importantly, the IgG4-related group did not completely overlap with fibrous variant of Hashimoto's thyroiditis. Four cases (14%) in the IgG4 thyroiditis group presented only mild fibrosis in the stroma, whereas 29 cases (38%) in the non-IgG4 thyroiditis group met the diagnostic criteria for fibrous variant of Hashimoto's thyroiditis. Furthermore, we observed three patterns of stromal fibrosis in Hashimoto's thyroiditis: interfollicular fibrosis, interlobular fibrosis, and scar fibrosis. The IgG4 thyroiditis group was significantly associated with the presence of predominant interfollicular fibrosis. In conclusion, IgG4 Hashimoto's thyroiditis presents histopathological features quite distinct from its non-IgG4 counterpart.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Distinct histopathological features of Hashimoto's thyroiditis with respect to IgG4-related disease

Zhou

Ozaki

et al. 2012

Modern Pathology

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“…Follicular cell metaplasia, ranging from pale pink cells with abundant cytoplasm to true HCs with the characteristic granular, deeply eosinophilic cytoplasm, is commonly seen. Reflecting the apparent need for cells to accumulate significant numbers of mitochondria over a prolonged period of time, HC metaplasia is rarely seen in the juvenile form of CLT [16]. Although the disease entity in which Askanazy first described HCs, diffuse toxic goiter (Graves' disease), typically does not contain an abundance of HCs, they may be seen in cases of long-standing Graves' disease, in older individuals with the disease, or in patients with a history of Graves' disease who have undergone radioactive iodine ablation and subsequently develop nodular thyroid disease [9].…”

Section: Thyroid Pathology Associated With Hcsmentioning

confidence: 99%

The Significance of Hürthle Cells in Thyroid Disease

Cannon

2011

The Oncologist

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Learning Objectives After completing this course, the reader will be able to: Enumerate the variable thyroid pathological conditions in which Hürthle cells are seen and explain the significance of the findings within the appropriate clinical context. Describe the various means by which Hürthle cell neoplasms may be evaluated and their value in determining the likelihood of a benign or malignant lesion. This article is available for continuing medical education credit at http://CME.TheOncologist.com Hürthle cells (HCs) and HC change, along with the frequently employed synonyms “oncocytes/oncocytic change” or “oxyphils/oxyphilic change,” are not infrequently described on fine‐needle aspiration biopsy (FNAB) reports of thyroid lesions. The description of HCs on FNAB reports may cause significant concern to the clinician; however, placing the finding in the appropriate clinical context may alleviate some anxiety. Not all oxyphilic cells are true HCs and not every aspirate containing HCs is or should be considered equivalent to an HC neoplasm (HCN). There are many benign thyroid lesions associated with HCs or HC change. For clinicians, it may be difficult to discern the significance of these findings and to determine an appropriate course of action. A skilled and experienced cytopathologist is invaluable in discriminating the subtle features that distinguish these lesions from those warranting a more aggressive approach. The diagnosis of HC carcinoma relies on histopathologic scrutiny and evidence of capsular and/or vascular invasion or metastasis to lymph nodes or distant organs. Many investigators have sought clinical, radiographic, cytological, genetic, and other factors to attempt to discriminate preoperatively between benign and malignant HCNs. To date, none have been definitively proven to be reliable. For now, because of the inability to determine the benign or malignant nature of such neoplasms based on cytology alone, a surgical approach is warranted.

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“…Tezuka et al (23) proposed another hypotheses, which was that perfusion due to augmented intrathyroidal blood flow and vascularity (characteristic of GD) might account for the significantly higher ADC values of GD, as compared with those of subacute thyroiditis and Hashimoto thyroiditis. It is also evident that, as in PT, lymphocytic infiltration is a prominent feature in subacute thyroiditis and Hashimoto thyroiditis (29), which will result in hypercellularity. This may explain why the results of the present study are consistent with those of Tezuka et al MR imaging is non-invasive, since no injection of contrast material is required.…”

Section: Discussionmentioning

confidence: 99%

“…PT is a syndrome of thyrotoxicosis due to the release of preformed thyroid hormones from disrupted thyroid follicles. The diffuse infiltration of the thyroid by lymphocytes implies that it is also an autoimmune disorder (28,29). RAIU testing or thyroid scintigraphy is of high diagnostic value for differentiating between GD and PT, and has been demonstrated to be reliable (11-14); however, RAIU and thyroid scintigraphy reflect only one type of change in the pathogenesis of the two diseases.…”

Section: Discussionmentioning

confidence: 99%

Differentiation between Graves' disease and painless thyroiditis by diffusion-weighted imaging, thyroid iodine uptake, thyroid scintigraphy and serum parameters

Meng

Zhang

Sun

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to assess the apparent diffusion coefficient (ADC) in diffusion-weighted imaging (DWI), thyroid radioactive iodine uptake (RAIU), thyroid scintigraphy and thyrotropin receptor antibody (TRAb) levels in the differential diagnosis between Graves' disease (GD) and painless thyroiditis (PT). A total of 102 patients with GD and 37 patients with PT were enrolled in the study. DWI was obtained with a 3.0-T magnetic resonance scanner, and ADC values were calculated. RAIU and thyroid scintigraphy were performed. Tissue samples were obtained from patients with GD (6 cases) following thyroidectomy, and from patients with PT (2 cases) following biopsy. Receiver operating characteristic (ROC) curves were drawn, optimal cut-off values were selected, and the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were assessed. It was found that the ADC, TRAb and RAIU were significantly higher in GD than in PT (P<0.05). ROC curves showed areas under the curves for RAIU, ADC and TRAb that were >0.900. RAIU was the reference method. Sensitivity, specificity, accuracy, PPV and NPV were 96. 078, 91.892, 95.000, 97.059 and 89.474% for ADC, and 88.235, 75.676, 84.892, 90.909 and 70.000% for TRAb, after the optimal thresholds of 1.837x10 -3 mm 2 /sec and 1.350 IU/ml were determined respectively. Histopathology showed that tissue cellularity in PT was much higher than in GD due to massive lymphocytic infiltration. The results of the present study indicate that RAIU, ADC and TRAb are of diagnostic value for differentiating between GD and PT. DWI has great potential for thyroid pathophysiological imaging because it reflects differences in tissue cellularity between GD and PT.

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The Pathology of Autoimmune Thyroid Disease: A Review

Cited by 122 publications

References 101 publications

Distinct histopathological features of Hashimoto's thyroiditis with respect to IgG4-related disease

Distinct histopathological features of Hashimoto's thyroiditis with respect to IgG4-related disease

The Significance of Hürthle Cells in Thyroid Disease

Differentiation between Graves' disease and painless thyroiditis by diffusion-weighted imaging, thyroid iodine uptake, thyroid scintigraphy and serum parameters

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