Thyroid gland
Competency Assessment
5. Benign thyroid lesions

Author: Ricardo R. Lastra, M.D., Michelle R. Pramick, M.D., Zubair W. Baloch, M.D. (see Authors page)

Revised: 20 January 2017, last major update November 2013

Copyright: (c) 2013-2017, PathologyOutlines.com, Inc.

Cite this page: Benign thyroid lesions. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/thyroidcompbenignthyroid.html. Accessed January 24th, 2017.
Nodular Goiter
Medical knowledge
  1. Recognize the various etiologies of nodular goiter
    • Inadequate iodine intake
    • Drugs and chemicals
    • Hereditary enzyme deficiencies
    • Idiopathic
  2. Recognize the cytologic criteria and arrangement patterns of follicular cells in smears of nodular goiter
  3. Recognize background elements classically associated to nodular goiter
    • Abundant colloid
    • Macrophages
  4. Recognize symptoms associated to nodular goiter
    • Aesthetic
    • Compressive
    • Endocrine

Practice based learning
  1. Apply the criteria that allow for distinction between nodular goiter, hyperplastic / adenomatoid and follicular neoplasm
    • Number of nodules in gland
    • Size of follicles
    • Size and distribution of follicular cells
    • Encapsulation of nodule
    • Background elements
  2. Recognize the role of elevated TSH in the pathophysiology of nodular goiter


Images hosted on other servers:

Cytology images:

Watery colloid

Watery colloid and focal dense colloid

Large amounts of background colloid

Thick, deep blue colloid with cracking


Thick, deep blue colloid with bubble pattern

Sheet of benign follicular epithelial cells

Fig 18-1a: benign epithelial cells, colloid, macrophages

Thin Prep versus pap stain

Hyperplastic / Adenomatoid Nodule
Medical knowledge
  1. Recognize the cytologic criteria and arrangement patterns of follicular cells in smears of hyperplastic / adenomatoid nodules
  2. Recognize normal range and variability of hyperplastic / adenomatoid nodules in relation to cellularity and colloid content

Practice based learning
  1. Apply the criteria that allow for distinction between nodular goiter, hyperplastic / adenomatoid and follicular neoplasm
    • Number of nodules in gland
    • Size of follicles
    • Size and distribution of follicular cells
    • Encapsulation of nodule
    • Background elements
  2. Understand the significance of clinical history and radiology in the differential diagnosis of hyperplastic / adenomatoid nodules and follicular neoplasms
  3. Recognize the limitations of cytology in the diagnosis of hyperplastic / adenomatoid nodules and follicular neoplasms in cases with overlapping features


Images hosted on other servers:

Cytology images:

Pediatric solitary papillary hyperplastic thyroid nodule

Chronic Lymphocytic Thyroiditis
Medical knowledge
  1. Understand the epidemiology of chronic lymphocytic thyroiditis
  2. Recognize the main endocrine manifestations of chronic lymphocytic thyroiditis
  3. Understand the pathophysiology of chronic lymphocytic thyroiditis as a classic autoimmune process
  4. Recognize the antibodies characteristically associated to chronic lymphocytic thyroiditis
    • Antithyroglobulin antibodies
    • Antimicrosomal antibodies
  5. Recognize the characteristic cytologic appearance of chronic lymphocytic thyroiditis
    • Frequently hypercellular specimen
    • Variable number of follicular cells and / or Hürthle cells with occasional mild nuclear atypia
    • Polymorphic lymphoid population with occasional plasma cells in background forming characteristic "lymphoid tangles"

Practice base learning
  1. Recognize that Hashimoto's thyroiditis is a clinico-pathologic diagnosis, not to be used in the reporting of thyroid FNAs
  2. Recognize the cytokine effect on follicular cells present in chronic lymphocytic thyroiditis as a potential mimic of papillary thyroid carcinoma
  3. Be aware of the increased incidence of lymphoma in chronic lymphocytic thyroiditis
  4. Differentiate chronic lymphocytic thyroiditis with prominent Hürthle cell changes from oncocytic follicular neoplasms


Images hosted on other servers:

Cytology images:

Oncocytic cells with atypical nuclei

Sheet of follicular cells with oncocytic change mixed with benign lymphoid cells (third image also has giant cells)

Resembles lymphoma


Thin Prep versus pap stain

Grade I: mild lymphocytic inflammatory infiltrate

Grade II: moderate lymphocytic inflammation

Grade III: marked
inflammation with
polymorphous
lymphocytes

Other Inflammatory Conditions of the Thyroid
Medical knowledge
  1. Understand the epidemiology, pathophysiology and main clinical and cytologic characteristics of classic inflammatory processes of the thyroid
    • Acute thyroiditis
    • Granulomatous (subacute, de Quervain's) thyroiditis
    • Riedel's thyroiditis
    • Grave's Disease
      • Role of thyroid stimulating immunoglobulin
      • Characteristic "flame cell"

Practice based learning
  1. Recognize the significance of these diagnosis or treatment and followup of the patient
  2. Differentiate Riedel's thyroiditis from the fibrotic stage of chronic lymphocytic thyroiditis
  3. Recognize architectural and cytologic features of Grave's disease as potential mimics of neoplastic / malignant follicular processes
  4. Recognize the extrathyroidal manifestations of Grave's disease


Images hosted on other servers:

Cytology images, subacute thyroiditis:

Syncytial cluster of epithelioid cells with oval nuclei

Large multinucleated giant cell

Multinucleated giant cells in case associated with renal cell carcinoma

Multinucleated giant cells and individual epithelial cells

Epithelioid cells and lymphocytes