Home > E. Pathology by systems > Endocrine system > Thyroid gland > Graves hyperthyroidism
Graves hyperthyroidism
Thursday 12 January 2006
autoimmune hyperthyroidism, Graves disease, diffuse toxic goiter; Primary thyroid hyperplasia
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Images
Atypia in Graves’ Disease, usually therapy related
Digital case
JRC:18921 : Primary hyperplasia (Graves’ disease) with moderate involution.
Microscopy
hyperplastic thyroid follicles
follicles with papillary infoldings
diffuse follicular hyperplasia
hypertrophy of follicular cells
retention of lobular architecture
prominent vascular congestion
tall follicular cells
epithelial papillae usually lacking fibrovascular cores
round nuclei
basally located nuclei
rarely overlapping nuclei
typically decreased colloid , when present shows peripheral scalloping
variable patchy lymphoid infiltrate in the stroma
nuclear clearing (15%
florid papillary hyperplasia (13%, may resemble papillary thyroid carcinoma)
nuclear grooves or pseudonuclear inclusions (8%)
nuclear enlargement
multinucleation
nuclear pleomorphism or prominent nucleoli (7%)
mitotic figures (6%)
psammoma bodies (1%)
hyperplastic follicles may extend into adjacent skeletal muscle (1%)
rarely small clusters of normal thyroid follicles in adjacent lymph node sinuses (Hum Pathol 2008;39:1080)
NB :
preoperative potassium iodide to suppress vascularity causes epithelial involution and colloid accumulation
Gland may look normal after 3 weeks of treatment
Preoperative PTU exaggerates the hyperplasia and hypertrophy
Radioactive iodine initially causes dissolution of some follicles, vascular changes, nuclear atypia and stromal fibrosis. Late changes are follicular atrophy, fibrosis, nodularity and oncocytic changes
Periorbital tissue: lymphoplasmacytic infiltrate present in periorbital soft tissue and extraorbital skeletal muscles
Skin hyperkeratosis: deposition of acid mucopolysaccharides in dermis
possible follicular cell atypia in Graves disease, usually therapy-related
Differential diagnosis
papillary thyroid carcinoma
- enlarged overlapping nuclei
- nuclear grooves
- nuclear inclusions
Predisposition
Locus 2q33: CTLA4
Locus 4q12: GC
Locus 6p11: AITD1 (MIM.608173)
Locus 5q31-q33: AITD2 (MIM.608174)
Locus 8q24: AITD3 (MIM.608175)
Locus 10q: AITD4 (MIM.608176)
Locus 18q21: AITD5 (MIM.601941)
Locus 12q12-q14: VDR
Locus 14q31: GRD1
Locus 20q13.11: GRD2
Locus Xp11: GRDX
Locus Xq21.33-q22: GRD3
See also
thyroid diseases
- thyroid dysimmune diseases
References
Brent GA. Clinical practice. Graves’ disease. N Engl J Med. 2008 Jun 12;358(24):2594-605. PMID: 18550875
