Download Practical pathology of thyroid

Practical pathology of thyroid
Case 1
• A 50 yr old lady presents
with a mass in anterior
neck, slowly growing
since 10 yr ago. It is soft
and nodular, and moves
with swallowing. No
cervical LAD felt. Rest of
PE is normal.
Work - up
• Thyroid hormone
profile ordered :
• TSH : 3.5 IU/L
( 0.5 – 5 IU/L )
• T4 : 6.2 micgr/dl
( 4.5 – 12 micgr/dl )
• T3 : 134 ng/ dl
( 100 – 220 ng/dl )
• T3RU : 24 %
( 20 - 35 % )
Work-up
• Thyroid scan ordered
Thyroid scan
Thyroid FNA performed :
Clin. Diag :
Multinodular goiter
• Patient underwent surgery :
Microscopic images
Microscopic images
Microscopic images
Final diagnosis :
•
Multinodular Goiter
Case 2
• A 45 yr-old lady presents with a lump in
anterior part of neck at right thyroid lobe,
slowly growing since 4 months ago. The
mass is firm and indiscrete, and moves with
swallowing. Other physical exams are
normal. No cervical LAD is present. She
has Hx. Of Raynaud’s phenomenon.
Thyroid hormone profile ordered :
• TSH : 7.2 IU/L
• T4
: 4.1 micgr/dl
• T3
: 105 ng/dl
Thyroid FNA performed :
Diagnosis : Hashimoto’s thyroiditis
Hashimoto’s thyroiditis
Case 3
• A 33 yr-old man presents with firmness of
his left thyroid lobe and a nodule in left
cervical chain, growing since 2 wks ago.
The latter nodule is soft, but the left thyroid
is firm. Other exams are normal.
Next work-up step :
Diagnosis :
• Papillary carcinoma of thyroid with cervical
lymph node metastasis
• Patient underwent total thyroidectomy and
left cervical LN resection
Papillary CA of thyroid