differential diagnoses of goiter

8/14/2019 Differential Diagnoses of Goiter

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Differential Diagnoses of

Thyroid MassBy: Marika Allego

Anacleto ClentBanaay

Chanidaporn Artkla

Princess AmeerahAbbas

Edzelle Marie

AndalahaoMary Grace

Bernardo

Kaye Sahara Cagoco

NatanichaAdunyatham



Clinical Senario:

• Signs and symptoms of Hyperthyroidism

Anxiety, Rapid speech, dyspnea on

exertion, generalized weakness,tremors, Fatigue, restlessness,sweating, palpitations, irregularmenses, inc, appetite, eyelidswelling, hypertension, osteoarthritis



Physical Exam:

BP: 210/90Weight: 82.1 kg

Height: 165 cmGeneral survey: Anxious, starring

gaze, chemosis, lidlag, Tremors of outstretched hand, proximalmyopathy, spasms



Laboratory findings:

• Thyroid scintigram: Symmetricallyenalrged gland w/ Homogenoustracer distribution and a prominent

pyramidal lobe

• Radioiodine uptake: Elevated (80%)

• Positive for HLA-DQB1, HLA-DRB3

and HLA-DEB4 antigens



Differential diagnoses of Goiter:1.Graves' diseaseIncidence: -Autoimmune disease -It has a strong hereditary

component -It affects up to 2% of the female

population -the most common etiology with

70-80%



Pathology of Grave’sdisease:•

Characteristics: ( Clinical triad)-Hyperthyroidism-Infiltrative opthalmopathy resulting to

exopthalmos-DermopathyClinical findings:

-Elevated free T4 and T3, depressed TSH, inc. Radioiodine uptake, (+) for TSI, TGI, TBII



Morphological findings inGrave’s disease-symmetrically enlarged thyroid gland-Diffuse hyperthropy and

Hyperplasiapf follicles-formation of Papillae projecting inot

the follicular lumen-colloids fills the follicles-Lymphoid infiltrates predominantly T

cells, fe B cells and mature Plasmacells

-Germinal centers are common.



2. Multinodular (toxic)Goiter

Incidence:-AKA : Plummer’s disease

- enlarged thyroid gland that contains asmall rounded growth or growths called

nodules.- arises from an existing simple goiter.

- female and over 60 years old.

- It is the second most common cause of hyperthyroidism

Pathology:-Signs and symptoms of hyperthyroidism

but no Exopthalmus



Clinical findings of Multinodular( toxic) Goiter:-Serum thyroid hormone levels (T3, T4)

are high. Serum TSH (thyroidstimulating hormone) is low.

-Thyroid scan shows that the nodules aretaking up increased amounts of radioactive iodine

Morphology:-Multilobulated, assymmetrical enlarged

gland

-Gelatinous colloid are present in thefollicles.

3 H hi ' h idi i



3. Hashimoto's thyroiditis orchronic lymphocytic

thyroiditisIncidence:

- antibody mediated immune process.

- most prevalent between 45 and 65years of age.

- occurs far more often in women

Pathology and clinical feature:-HypothyroidismAutoimmune disease



Morphology of Hashimoto’sthyroiditis

- Diffusedly Enlarged Thyroid gland

- Mononuclear inflammatory infiltrates

- Well developed germinal centers

- Presence of Hurthle cells( Eosinophilic, granular cells)

- Thyroid follicular atrophy

- “Keloid-like” fibrosis- Feature: Chronic lymphocytic

thyroiditis

-



4. Thyroid neoplasm

-malignant tumors of the thyroidgland: papillary, follicular, medullaryor anaplastic

- Papillary and follicular tumors are themost commonIncidence:

-Common in women- Increased incidence ad age increases

- Benign and Malignant occurence



ADENOMA

Morphology:-Solitary, Spherical encapsulated

lesion

-well demarcated and intact capsule-Uniform appearing follicles containing

colloid

-Can be Hurthle cell adenoma oratypical follicular adenomaClinical features:

-Hyperthyroidism, suppressed TSH



CARCINOMA

Incidence:-Uncommon-Female predominance Types:

1.Papillary carcinoma

2.Follicular carcinoma

3.Medulary carcinoma

4.Anaplastic carcinoma

5



5.Subacute( Granulomatous)

ThyroiditisIncidence:-Common in Ages 30-50-more in Women

Pathology:-Caused by Viral infection or a postviral

inflammatory processMorphology:

-Unilaterally or bilaterally enlarged, firm, intactcapsule-Scattered follicles may be disrupted-Aggregates of Lymphocytes, histiocytes, plasma

cells in the thyroid follicles-Multinucleate iant cells in the colloid



6. Subacute LymphocyticThyroiditis

-Referred to as: Painless Thyroiditis orsilent thyroiditis

Incidence:-Occur at any age, more in womenPathology:-Autoimmune is suggestedMorphology:-Mild symmetric enlargement;

Lymphocytic infiltrates with

hyperplastic germinal centers



Clinical features:

- Mild hyperthyroidism

- -No opthalmopathy and grave’sdisease signs

- Elevated T4 and T3, LOW TSH

-



Presumptive Diagnosis

differential diagnoses of goiter

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