Let’s talk about Hashimoto’s in great
Most common of the hypothyroidism in the world,
early in the course presents how?
Once again, Hashitoxicosis, we have had the
Characterized by gradual thyroid failure,
initially there might be release of T3, T4,
eventually leading into permanent, permanent,
permanent primary hypothyroidism, most prevalent
in elderly females, autoimmune, 20:1 ratio
of women to men and you want to memorize by
all means HLA-DR5 and B5.
Pathogenesis, what happens?
You have anti thyroglobulin antibodies, you
might have antibodies that are attacking thyroid
peroxidase TSH receptors.
Do you see anywhere along the line of thyroid
hormone synthesis, you might have autoantibodies
that are then-that are then attacking it resulting
in primary hypothyroidism.
If I were you, I would pay attention to the
first two bullet points.
Autoimmune disease, it is going to be diffused
enlarged on the thyroid.
Notice, I did not say diffused radioactive
iodine uptake, huh!
Firm, non-tender goiter, hypothyroidism preceded
by transient thyrotoxicosis, one more time,
due to the release of your thyroid hormones
from your colloid.
Eventually, gland becomes shrunken and dead,
it is with lymphocytic infiltration.
In fact, if you were to take a look at the
picture here, histologically, you will notice
a swarm of “bees” referring to lymphocytes
coming in there and completely annihilating
or just about completely annihilating this
It is very difficult for us to clearly identify
a normal thyroid follicular cell.
You don’t find the normal colloid that you
would expect to see and at this point, I fully
expect you to know what a normal thyroid follicular
cell looks like with that central region of
And with all this lymphocytic infiltration,
no wonder your thyroid gland is going to be
Cytology upon FNA, what is variable, but nonetheless,
things that you want to keep in mind include
lymphocytic infiltration at which point flow
cytometry is warranted.
Hurthle cells; H - Hashimoto, H - Hurthle
cells, you must know the other name, the alias
is oncocytes, which you must know the description.
Gone are the days of buzzwords, you might
have an attending who might ask you the des-
the description of a Hurthle cell and you
don’t want to just stare back at him or
her and come across as being clueless, right?
Hurthle cells are large polyclonal cells with
abundant what is known as oxyphil cytoplasm,
it provides false positive cytologic diagnosis
of Hurthle cell tumor.