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6 - Thyroiditis and mimickers

Published online by Cambridge University Press:  05 September 2014

Grace C. H. Yang
Grace C. H. Yang
Affiliation:
Weill Medical College of Cornell University
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Summary

Acute suppurative thyroiditis

The thyroid gland is resistant to infection, because of its encapsulation, high iodide content, rich blood supply, and extensive lymphatic drainage, therefore suppurative thyroiditis is rare. It is a potentially life-threatening endocrine emergency, most likely to occur in patients with preexisting thyroid disease. The most common etiology is bacterial infection, except in immunocompromized patients. With effective antibiotic therapy and elimination of formed abscesses by ultrasound-guided FNA, patients typically have an excellent prognosis if they survive the acute episode. The author encountered one case in 1993. FNA of acute suppurative thyroiditis is characterized by fibrinopurulent exudate containing numerous neutrophils, just like the aspirates from any other sites.

Riedel's thyroiditis

Riedel's thyroiditis is a progressive fibrosis of the thyroid gland that may extend to surrounding tissues of unknown etiology. Patients with Riedel's thyroiditis present with a rock-hard, fixed, painless thyroid nodule. FNA of Riedel's thyroiditis would be non-diagnostic, since no colloid or follicular cells would be aspirated. However, the acellular yield would support the clinical impression of Riedel's thyroiditis.

Subacute /De Quervain's thyroiditis

Subacute thyroiditis, also known as subacute granulomatous thyroiditis, is a self-limited thyroid condition associated with a triphasic clinical course of hyperthyroid, hypothyroid, and euthyroid. Laboratory tests early in the course of the disease may show low serum TSH (thyroid-stimulating hormone) level, high serum free T4 (thyroxine) level, low radioactive iodine uptake, and high erythrocyte sedimentation rate. The high T4 level results from release of pre-formed thyroid hormone into the circulation from the ruptured thyroid follicles. Laboratory tests later in the disease may show high serum TSH level and low serum free T4. Subacute thyroiditis may be responsible for 15–20% of patients presenting with thyrotoxicosis and 10% of patients presenting with hypothyroidism. Recognizing this condition is important, because it is self-limiting, and there is no specific therapy.

Type
Chapter
Information
Thyroid Fine Needle Aspiration , pp. 213 - 247
Publisher: Cambridge University Press
Print publication year: 2013

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References

Paes, JE, Burman, KD, Cohen, J, et al. Acute bacterial suppurative thyroiditis: a clinical review and expert opinion. Thyroid 2010; 20: 247–55.CrossRefGoogle ScholarPubMed
Ilyin, A, Zhelonkina, N, Severskaya, N, Romanko, S.Nonsurgical management of thyroid abscess with sonographically guided fine needle aspiration. J Clin Ultrasound 2007; 35: 333–7.CrossRefGoogle ScholarPubMed
Hennessey, JV.Riedel's thyroiditis: A clinical review. J Clin Endocrinol Metab 2011; 96: 3031–41.CrossRefGoogle ScholarPubMed
Pearce, EN, Farwell, AP, Braverman, LE.Concurrent concepts: Thyroiditis. N Engl J Med 2003; 348: 2646–55.CrossRefGoogle Scholar
Volpe, R, Row, VV, Ezrin, C.Circulating viral and thyroid antibodies in subacute thyroiditis. J Clin Endocrinol Metab 1967; 27: 1275–84.CrossRefGoogle ScholarPubMed
Roti, E, Emerson, CH.Postpartum thyroiditis. J Clin Endocrinol Metab 1992; 74: 3–5Google ScholarPubMed
Mai, VQ, Glister, BC, Clyde, PW, Shakir, KM.Palpation thyroiditis causing new-onset atrial fibrillation. Thyroid 2008; 18: 571–3.CrossRefGoogle ScholarPubMed
Espiritu, RP, Dean, DS.Parathyroidectomy-induced thyroiditis. Endocr Pract 2010; 16: 656–9.CrossRefGoogle ScholarPubMed
Schwartzentruber, DJ, White, DE, Zweig, MH, et al. Thyroid dysfunction associated with immunotherapy for patients with cancer. Cancer 1991; 68: 2384–90.3.0.CO;2-A>CrossRefGoogle ScholarPubMed
Lu, C -P, Chang, T -C, Wang, C -Y, Hsiao, Y -L.Serial changes in ultrasound-guided fine needle aspiration cytology in subacute thyroiditis. Acta Cytol 1997; 41: 238–43.CrossRefGoogle ScholarPubMed
Solano, JG, Bascunana, AG, Perez, JS, et al. Fine-needle aspiration of subacute fine-needle aspiration of subacute granulomatous thyroiditis (De Quervain's thyroiditis): A clinico-cytologic review of 36 cases. Diagn Cytopathol 1997; 3: 214–20.3.0.CO;2-F>CrossRefGoogle Scholar
Shabb, NS, Salti, I.Subacute thyroiditis: Fine-needle aspiration cytology of 14 cases presenting with thyroid nodules. Diagn Cytopathol 2006; 34: 18–23.CrossRefGoogle ScholarPubMed
Vanderpump, MP, Tunbridge, WM. Epidemiology and prevention of clinical and subclinical hypothyroidism. Thyroid 2002; 12: 839–47.CrossRefGoogle ScholarPubMed
Chistiakov, DA.Immunogenetics of Hashimoto's thyroiditis. J Autoimmune Dis 2005; 2: 1.CrossRefGoogle ScholarPubMed
Rapoport, B, McLachlan, SM.Thyroid autoimmunity. J Clin Invest 2001; 108: 1253–9.CrossRefGoogle ScholarPubMed
Wan, Q, Shah, R, Panos, JC, et al. HLA-DR and HLA-DQ polymorphism in human thyroglobulin-induced autoimmune thyroiditis: DR3 and DQ8 transgenic mice are susceptible. Hum Immunol 2002; 63: 301–10.CrossRefGoogle ScholarPubMed
Heilo, A, Sigstad, E, Grøholt, K.Atlas of Thyroid Lesions. New York: Springer, 2011.CrossRefGoogle Scholar
Repplinger, D, Bargren, A, Zhang, YW, et al. Is Hashimoto's thyroiditis a risk factor for papillary thyroid cancer?J Surg Res 2008; 150: 49–52.CrossRefGoogle ScholarPubMed
Shih, ML, Lee, JA, Hsieh, CB, et al. Thyroidectomy for Hashimoto's thyroiditis: Complications and associated cancers. Thyroid 2008; 18: 729–34.CrossRefGoogle ScholarPubMed
Huang, BY, Hseuh, C, Chao, TC, Lin, KJ, Lin, JD.Well-differentiated thyroid carcinoma with concomitant Hashimoto's thyroiditis present with less aggressive clinical stage and low recurrence. Endocr Pathol 2011; 22: 144–9.CrossRefGoogle ScholarPubMed
Yang, GCH, Papellas, J.Retraction halos: Nature's dotting pen in effusion cytology processed by Ultrafast papanicolaou stain. Diagn Cytopathol 2008; 36: 613–17.CrossRefGoogle ScholarPubMed
Apel, RL, Asa, SL, LiVolsi, VA.Papillary Hürthle-cell carcinoma with lymphocytic stroma: “Warthin-like tumor” of the thyroid. Am J Surg Pathol 1995; 19: 810–14.CrossRefGoogle ScholarPubMed
D'antonio, A, De, Chiara A, Santoro, M, et al. Warthin-like tumour of the thyroid gland: RET/PTC expression indicates it is a variant of papillary carcinoma. Histopathology 2000; 36: 493–8.CrossRefGoogle ScholarPubMed
Ludvikova, M, Ryska, A, Korabecna, M, et al. Oncocytic papillary carcinoma with lymphoid stroma (Warthin-like tumour) of the thyroid: A distinct entity with favourable prognosis. Histopathology 2001; 39: 17–24.CrossRefGoogle ScholarPubMed
Feinmesser, M, Stern, S, Mechlis-Frish, S, et al. HLA-DR expression and lymphocytic infiltration in metastatic and non-metastatic papillary carcinoma of the thyroid. Eur J Surg Oncol 1996; 22: 494–501.CrossRefGoogle ScholarPubMed
Kawai, K, Rsetkova, E, Enomoto, T, Fornasier, V, Volpe, R.Is human leucocyte antigen-DR and intercellular adhesion molecule-1 expression on human thyrocytes constitutive in papillary thyroid cancer? Comparative studies in human thyroid xenografts in severe combined immunodeficient and nude mice. J Clin Endocrinol Metab. 1998; 83: 157–64.Google Scholar
Baloch, ZW, LiVolsi, VA.Warthin-like papillary carcinoma of the thyroid. Arch Pathol Lab Med 2000; 124: 1192–5.Google ScholarPubMed
Yousef, O, Dichard, A, Bocklage, T.Aspiration cytology features of the Warthin tumor-like variant of papillary thyroid carcinoma – A report of two cases. Acta Cytol 1997; 41: 1361–8.CrossRefGoogle ScholarPubMed
Derringer, GA, Thompson, LDR, Frommelt, RA, et al. Malignant lymphoma of the thyroid gland: A clinicopathologic study of 108 cases. Am J Surg Pathol 2000; 24: 623–39.CrossRefGoogle ScholarPubMed
Sangalli, G, Serio, G, Zampatti, C, Lomuscio, G, Colombo, L.Fine needle aspiration cytology of primary lymphoma of the thyroid: A report of 17 cases. Cytopathology 2001; 12: 257–63.CrossRefGoogle ScholarPubMed
Chen, HI, Akpolat, I, Mody, DR, et al. Restricted kappa/lambda light chain ratio by flow cytometry in germinal center B cells in Hashimoto thyroiditis. Am J Clin Pathol 2006; 125: 42–8.CrossRefGoogle ScholarPubMed
Zeppa, P, Cozzolino, I, Peluso, AL, et al. Cytologic, flow cytometry, and molecular assessment of lymphoid infiltrate in fine-needle cytology samples of Hashimoto thyroiditis. Cancer 2009; 117: 174–84.Google ScholarPubMed

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