THYROID

H M Nadjib Dahlan Lubis

Bag Patologi Anatomi Fak Kedokteran
USU/UISU

ECTOPIC THYROID
Lingual
Lingual + Normal
Sup Mediastinum
Thyroglossal cyst
Pit Thyrotrophin syntesa, jml & besar fol
Iodide Oxid + thyrosine mol MIT + Thyroglo
DIT
Thyroxine (T4) mayor
Triiodothyronine (T3)
Peripheral Met
T4 / T2 plasma protein; TBG, TB PA
99%: inactive
T4 : T3 : 40 : 1

Function
Basic energy Met: prot syn
oxidative posphorilation in mitochond

Structure
Klinis palpasi
Radiologi: - 125 I filling defect, cold nod low uptake
- USG cystic / solid
Biopsy
Pem Fungsi
Radioimmunoassay Protein bound
Free hormon
T4/T3 dipengaruhi: : peny liv, ren & Cong
: preg, oral cont
Ultrasensitive Serum TSH
TRH Stimulator Test

Ggn Sekresi
Excessive (Hyperthyroidism), Thyrotoxicosis
Aet: - Grave Autoimm
- Rare : - Multi Nod
- Fol Ad fuct, Ca
- Thyrotrophin sec Pit Ad
- Germ cell Tum
- Thyroiditis
Cli: - Nerv, anxiety, insomnia, fine tremor
- BW
- Heat Intolerance, sweating
- Palp, Tachy, Card Arrh, Card Fail, Atr Fibr
- Amenorrhoe, Infertility
- Otot lemah, limb girdle (prox myopathy)
- Osteoporosis pain

Hypothyroidism: - Child Cretinism

- Adult Myxedema
Pbg: - Pri
- Sec Pit TSH

Cretinism
Aet: - Agenesis
- Synt def (iodized) : - preg
- after birth
- Goitrogen block synt : thyocyanate : cassava plant
- Autorec enzym def
Synt hyperplasia Pit Thyrotrophin Goitrous Creatinism
Cli: - Lethargy Somnolence, Hypothermia
- Hoarse cry, Hypotonia otot, large prot tongue
- Growth, mental reatrdation

Myxedema
Aet: - Hashimoto Autoimm Thyroiditis
- Pit failure
- Iatrogenic : - anti thy drug
- Ablation / Rad
- Diet : - Iodine def
- Goiterogen
Cli: - Lethargy
- Loss of hair: Scalp, eye bro
- Neuro : Ggn relax phase
- Anemia

- Pleural/Percard eff
- Serum Cholest
- Atherscl

Myxedema Mucopolysach Kulit nonpitting

Larynx Hoarseness
Heart >

Peny Thyroid: Immune

Grave: -

Hyperthyroidism
15-40 yrs
familial
+ pern ane, Hashimoto

Aet: Auto Ab IgG>< TSH Rec

Ab: -

LATS
LATS protector
TSI (Ig)
]
TSH binding inhibit. Ig (TBII) ] paling sering

Level serum Ig # severity

IgG Placenta Neonatal Hyperthyroidism

Pathology
>, sym, vasc
Fol Epit banyak, besar
Papill
Colloid sdkt, scalloped proteolytic thyroglobin
Lymhocyte / Lymphoid
Cli: - >
- Exopthalmous: starring gaze blinking
fungsi otot mata

Lab
Free Thyroxine T4 index
10% T4 N, Free T3 (T3 Toxicocic)
TSH serum
Exopthalmous - Lim
- Oed

- Mucopolysac
Infection

Blind
Pretibial no symptom other than itching

Hashimoto
Inc: - Middle age, F 10x M
- Histocomp HLA-DR S
Aet: - Cytotox T cell med hypersensitivity
- Serum Ab: - Anti thyroglob
- Anti microsomal
- >< coll lain dp thyroglob
- >< TSH rec
- Serum level Severity
Path: Firm, Rubbery, Bosselated atr, fibros
Mic: - Destr, Inf Lym
- Fol Epi besar, pink Hurtle cells.

Diagnose
Histology consistence with clinic
Hurtle (-) nonspe Lymph Thyroiditis
Clinic: - Euthyroid, Mild Hypothy
- Rare: mild hyperthyroidism (early)
- Most: progress hypothyroidism
The: - Replacement
- 5% mal: - Papillary Ca / Mal B cell lymphoma
- Cell B lymphoma

Inflammatory
Subacute Th is (Granulomatous, De Quervains)
Jarang, M & F
Virus upper resp
Auto Imm?: Ab anti thy: sementara
Relation to Grave / Hash (-)
Path: - diffus, >, keras, lekat
- dest, fibr, mac, giant cells
Clin: -

Acute, pain, fever, malaise, myalgia

Gen Euthy, hyperthy: sementar
Self limited: 3 mo
Not Hypothy

Riedel
Inc
Jarang, elder, F > M
Ab (-)
Hub: Fibr: retroper, mediast sistem fibroblast
Lymphocte, plasma
Woody
Cli: - sep mal, pain (-), rock
- Trachea Dyspnoe, Stridor
- Oes
Dysphagia
- N. Lar Hoarseness
- Euthy

Dif nontoxic & Multi Nodular Goiter

Mild def Hyperplasia compensatory
TSH N
Resp thd TSH ok depletion iodine dlm cell
Goiter = >> , any cause
Aet: - Endemic : - Def iod diet chr
- Pegunungan
- Seawater/seafoot
- F > M preg, lact
- Goiterogen: Cabbage, cassava
- Sporadic: - Demand : - puberty
- Preg

Pathology
Dif, > , nontox Multi Nod
Fol: small, tall coll sep Grave
Involusi: - Distention fol
- Flat / Cuboid
- Not Uniform
- Cut: gelatin / glistening
Cli: - Euthy
- Serum TSH Nm
- Surgery cosmetic
- Retrosternal
The: - Iodine / Thyroxin
- Surgery

- Fibrosis
- Hem
- Cyst
- Calcific

- Hyper thy > Hypothy ok ptb hyperpl nod

- Risk mal: small

NEOPLASM
Solitary Thyroid Nodule
Inc: - 4-7%, Mal < 5%
- 30%: Ben Fol Neo (Adenoma)
- Sisa: Nonneo: Col Goi, Hashimoto, Subac thyroiditis
- >60%: Ben Col Goi
FNA: - Mal ?
- Cell Foll lesion
- Ben Col

- Inconcl (mgk ben)

- Inconcl (mgk mal)
- Inadequate

Radionucleotide Scan: cold (Low) Risk mal surgery

USG: Beda cystic / solid

FOLLICULAR ADENOMA
Inc: - most common: 30% Sol Thy Nod
- Any age, F 4x M
Path: - Sol, grey, red 5 cm
- Hem, Fibr, calc, cystis
- Variasi: - Microfol
- Macrofol
- Solid cord Emb Ad

- Pink: Hurtle cell Ad

- Fibrous caps
- Normal Thy: compress
- Caps intact ]
- Vasc Inv
] beda dgn Ca

Cli: - Euthy
- Cold Nod
- Lab Test: diff Ad & Ca: nor possible

CARCINOMA
Inc Rad, Papillary, Follicular
Rad: - The resp distr 1950 5% mal 15-40 yrs
- Nuclear Mishap: Hiroshima & Nagasaki, Marshall, Chernobyl

RET Onccogen Chr 10: - Pap

- Med

PAPILLARY CARCINOMA
Most freq, F 3x M: 15-35 yrs
Size: Micr 10 cm
Mic: - Pap
- Clear Nuclei
- Nuclear Grooves
- Intranuc Cytoplasmic Vac
- Psammoma
- Fol Variant
Cli: -

Slow
Local inv caps
Lymp spread
60% opposite

- Cerv Node Met Aberrant; 40%

- Blood stream: rare

FOLLICULAR CARCINOMA
Inc: - 20% Ca thy
-F>M
- Middle age
Jenis: - Insular
- Trabecular
Syarat: Inv caps & Vasc
Slow blood stream bone, lung
Met lymp cerv krg dp Pap Ca

ANAPLASTIC CARCINOMA
Inc: - 5% Ca thy
- > 50 yrs
Infil, Nec, Hem
Met: fast

MEDULLARY CARCINOMA
Inc: - 5% Ca thy
- 10% familial: MEA type II: - Med Ca Thy
- Pheochromcytoma: Adr Med
- Adenoma: Parathy
Mic: - Calcitonin (Imm Peroxidase)
- Amyloid

CLINIC
-

Painless
Cold Nodule
Gen: Euthy, Well Diff Hyperthy
Local inv
Distant Met: - Pap Ca Cervical
- Fol Ca bone, lung

Tumor Marker
Calcitonin (Rad Imm Assay)
Pap & Fol Thyroglob Imm Peroxidase

Blood
Anaplastic: Glob (-)

Therapy
Surgery: Well Diff & Med
Well Diff Pap & Fol tgt Thyrotro penekanan TSH sec dgn
thyroxin ptb
Ext Radiation: Ana Ca
Prognosa

5 yrs
Pap: good
90%
Fol
65%
Med
50%
Mal Lymphoma - Elder
Ana - Comp Hashimoto- Imm B

20 yrs
85%
30%