IPLab:Lab 6:Hashimoto's Thyroiditis - Revision history

Peter Anderson: /* Images */

2020-07-08T23:31:27Z

‎Images

Peter Anderson: /* Images */

2020-07-08T23:26:33Z

‎Images

Peter Anderson: /* Autopsy Findings */

2020-07-08T23:19:16Z

‎Autopsy Findings

Peter Anderson: /* Clinical Summary */

2020-07-08T23:19:07Z

‎Clinical Summary

Seung Park at 16:17, 3 January 2014

2014-01-03T16:17:19Z

Seung Park: /* Images */

2013-08-30T01:35:06Z

‎Images

Peter Anderson at 20:29, 25 August 2013

2013-08-25T20:29:35Z

Seung Park at 21:47, 22 August 2013

2013-08-22T21:47:56Z

Seung Park at 21:47, 22 August 2013

2013-08-22T21:47:44Z

Peter Anderson at 15:24, 21 August 2013

2013-08-21T15:24:41Z

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 File:IPLab6Hashimoto1.jpg|This is a gross photograph of thyroid gland taken at autopsy. The gland is only slightly enlarged and has a firm texture.
 File:IPLab6Hashimoto3.jpg|This is a low-power photomicrograph of thyroid from this case. Note the large number of blue-staining inflammatory cells in this tissue. These blue cells appear to be forming germinal centers. Some residual thyroid gland tissue can be seen in this section (arrows).
-File:IPLab6Hashimoto5.jpg|This is a higher-power photomicrograph of thyroid from this case showing the inflammatory cells and the residual thyroid tissue.
+File:IPLab6Hashimoto5b.JPG|This is a higher-power photomicrograph of thyroid from this case showing the inflammatory cells and the residual thyroid tissue (arrow).
 File:IPLab6Hashimoto7.jpg|This is a high-power photomicrograph showing the inflammatory cells infiltrating into the residual thyroid tissue (arrows).
 File:IPLab6Hashimoto8.jpg|This is a high-power photomicrograph showing the lymphocytes and plasma cells surrounding the thyroid gland epithelium.

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 <gallery heights="250px" widths="250px">
 File:IPLab6Hashimoto1.jpg|This is a gross photograph of thyroid gland taken at autopsy. The gland is only slightly enlarged and has a firm texture.
-File:IPLab6Hashimoto2.jpg|This is a low-power photomicrograph of thyroid from this case. Note that the tissue is more cellular than one would expect and there does not appear to be normal colloid-filled blue spaces in this gland.
+File:IPLab6Hashimoto3.jpg|This is a low-power photomicrograph of thyroid from this case. Note the large number of blue-staining inflammatory cells in this tissue. These blue cells appear to be forming germinal centers. Some residual thyroid gland tissue can be seen in this section (arrows).
 File:IPLab6Hashimoto5.jpg|This is a higher-power photomicrograph of thyroid from this case showing the inflammatory cells and the residual thyroid tissue.
 File:IPLab6Hashimoto7.jpg|This is a high-power photomicrograph showing the inflammatory cells infiltrating into the residual thyroid tissue (arrows).
 File:IPLab6Hashimoto8.jpg|This is a high-power photomicrograph showing the lymphocytes and plasma cells surrounding the thyroid gland epithelium.
 </gallery>

← Older revision		Revision as of 23:19, 8 July 2020
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	On physical examination she had an enlarged thyroid gland with a firm, bosselated texture. Serum TSH was markedly elevated and antithyroid peroxidase antibodies were positive. These results supported the clinical impression of hypothyroidism; also, the texture of her thyroid gland and a positive family history suggested an autoimmune etiological factor. She was referred to an endocrinologist; however, before beginning treatment she died suddenly from a ruptured berry aneurysm.		On physical examination she had an enlarged thyroid gland with a firm, bosselated texture. Serum TSH was markedly elevated and antithyroid peroxidase antibodies were positive. These results supported the clinical impression of hypothyroidism; also, the texture of her thyroid gland and a positive family history suggested an autoimmune etiological factor. She was referred to an endocrinologist; however, before beginning treatment she died suddenly from a ruptured berry aneurysm.
−
−	~~== Autopsy Findings ==~~
−	At autopsy, significant subarachnoid hemorrhage from the ruptured berry aneurysm was documented. In addition, the thyroid gland was mildly enlarged and firm. On cut section the tissue was slightly pale.

	== Images ==		== Images ==

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 == Clinical Summary ==
-This was a 49-year-old woman who complained during her yearly physical examination of tiredness and difficulty concentrating. She attributed these symptoms to stress at work. She had gained weight over the last year and despite warm weather, she felt chilled without a sweater. Family history was significant for hypothyroidism in her mother and older sister. On physical examination she had a pulse of 58 bpm and a blood pressure of 138/88 mm Hg. Examination of her neck disclosed a small thyroid gland with a palpable pyramidal lobe and a firm, bosselated texture. Serum taken at this time demonstrated a total T4 of 7.0 mcg/dL and a TSH of 22.0 mcIU/ml. In addition, antithyroglobulin antibodies were positive at 1 to 640 and antimicrosomal antibodies were positive at 1 to 5120. These results supported the clinical impression of hypothyroidism; also, the texture of her thyroid gland and a positive family history suggested an autoimmune etiological factor. She was referred to an endocrinologist for further evaluation; however, before beginning treatment she died suddenly from a ruptured berry aneurysm of the middle cerebral artery.
+This was a 49-year-old woman who complained of tiredness and difficulty concentrating. She had gained weight over the last year and despite warm weather, she felt chilled without a sweater. Family history was significant for hypothyroidism in her mother and older sister.
 == Autopsy Findings ==

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 File:IPLab6Hashimoto9.jpg|This high-power photomicrograph shows more clearly the lymphocytes and plasma cells surrounding the thyroid gland epithelium. Large, eosinophilic, degenerating thyroid gland cells (Hurthle cells) can be seen in this section (arrows).
 </gallery>
 == Study Questions ==

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 === Images ===
-* [http://peir.path.uab.edu/library/index.php?/tags/15-endocrine/140-thyroid/141-lymphocytic_thyroiditis PEIR Digital Library: Lymphocytic Thyroiditis Images]
+* [{{SERVER}}/library/index.php?/tags/15-endocrine/140-thyroid/141-lymphocytic_thyroiditis PEIR Digital Library: Lymphocytic Thyroiditis Images]
 * [http://library.med.utah.edu/WebPath/ENDOHTML/ENDOIDX.html WebPath: Endocrine Pathology]

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 == Related IPLab Cases ==
-* [[IPLab:Lab 6:Graves Disease|Lab 6: Thyroid: Graves Disease]
+* [[IPLab:Lab 6:Graves Disease|Lab 6: Thyroid: Graves Disease]]
 {{IPLab 6}}
 [[Category: IPLab:Lab 6]]

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 * <spoiler text="What is the pathogenesis of Hashimoto’s thyroiditis and how does this disease differ from Grave’s disease or nutritional goiter?">Hashimoto's thyroiditis is characterized by Iymphocytic infiltration of the thyroid gland and production of antibodies that recognize thyroid-specific antigens. It is currently thought that the disease is caused by abnormal suppressor T-lymphocyte function which results in a localized cell-mediated immune response directed toward the thyroid parenchymal cells. The pathogenesis is not completely understood. In contrast Graves' disease is caused by production of antibodies that mimic the action of thyroid-stimulating hormone. Nutritional goiter is caused by iodine deficiency.</spoiler>
 * <spoiler text="What are some of the pathologic changes seen in Hashimoto's thyroiditis?">The gland is usually diffusely enlarged, firm, and slightly lobular. The capsule is intact, and the cut surface is light tan and has a slight lobular pattern. Microscopically there is massive infiltration of the thyroid gland by lymphocytes and plasma cells. Germinal centers can often be seen in the gland. Thyroid follicles are usually absent and the few remaining follicles are devoid of colloid.</spoiler>
 {{IPLab 6}}
 [[Category: IPLab:Lab 6]]