Thyroid morphology and function after subtotal resection for hyperthyroidism

Abstract

Two main patterns of hyperplasia of the thyroid epithelium are seen in hyperthyroidism--toxic diffuse hyperplasia and toxic nodular hyperplasia. Toxic diffuse hyperplasia may affect the entire gland or it may arise in the extranodular tissue in a gland with nodular lesions. A series of patients treated by subtotal thyroidectomy for hyperthyroidism were classified into three morphological groups of goitre: 98 had a toxic diffuse goitre (TDG), 58 toxic nodular goiter with diffuse hyperplasia (TNGDH), and 105 toxic nodular goitre with nodular hyperplasia (TNGNH). The type of goitre was correlated to the development of disturbed thyroid function 1-6 years after surgery. Twenty-two patients with TDG and 18 (31 per cent) with TNGDH developed hypothyroidism; only 3 (3 per cent) with TNGNH showed hypofunction. Six patients with recurrent hyperthyroidism were found; all showed diffuse hyperplasia of the gland. It is concluded that the development of disturbed thyroid function after surgery is closely related to the histopathological type of goitre.

The influence of remnant size, antithyroid antibodies, thyroid morphology, and lymphocyte infiltration on thyroid function after subtotal resection for hyperthyroidism

“…In toxic nodular goiter, the gradually intensifying toxicosis is assumed to be caused by a slowly increasing fraction of autonomously functioning follicles [25][26][27][28]. A previous report from this hospital suggested a close relationship between postoperative thyroid function and the morphological type of goiter, and that postoperative thyroid dysfunction is rare in patients with nodular hyperplasia [16]. Our study did not confirm these observations, although the same pathologist examined all the tissue specimens in both studies.…”

“…Sections, 5 /xm thick, were stained with hematoxylin-eosin and hematoxylin-van Gieson. All specimens were examined by the same pathologist and classified according to the type of goiter and occurrence of" significant lymphocyte infiltration" [16].…”

“…In fact, 3 types of goiters were distinguished: (a) diffuse changes in parenchyma with no nodules, consistent with toxic diffuse goiter; (b) diffuse changes in extranodular parenchyma in a thyroid gland containing 1 or more nodules, consistent with toxic nodular goiter with diffuse hyperplasia; and (c) hyperplasia in nodules only, consistent with toxic nodular goiter with nodular hyperplasia. Based on results in previous studies [16], we combined the first and second types, which were designated toxic diffuse goiter (TDG), whereas the third type was named toxic nodular goiter (TNG). Lymphoid tissue with a germinal center present in the thyroid tissue was considered "significant lymphocyte infiltration."…”

“…The present study indicates that the postoperative function of the remnant is correlated to its size in TNG whereas other factors may add their influence in case of TDG; hence, the morphological type could conceivably be useful for identifying potential risk groups as regards postoperative hypofunction. A macroscopically nodular goiter can, however, contain diffuse hyperplasia [16], and clearly the histopathological pattern is as a rule not apparent at the time of operation.…”

Treatment of toxic multinodular goiter (hummer's disease): Surgery or radioiodine?

“…2). The low probability of hypothyroidism after thyroidectomy at our institution in the early 1950s is similar to that reported in some series [5,15], while the increasing probabilities occurring in the 1960s and 1970s are similar to or higher than rates reported by other authors [3,16]. Although an increasing frequency of posttreatment hypothyroidism in recent decades has been reported with 131I therapy of toxic multinodular goiter [17], we are not aware that a similar finding has been reported after thyroidectomy.…”