International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - Vol 05 Issue 02, January, 2013

Pages: 42-44

Date of Publication: 30-Nov--0001


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UNUSUAL FINDING OF CYSTIC CHANGES IN HASHIMOTO'S THYROIDITIS: A REPORT

Author: Ashwini B.R., Sunita Vernekar, Rajeshwari Bhuttannavar

Category: Healthcare

Abstract:Hashimoto's thyroiditis(HT) is a chronic autoimmune thyroiditis affecting women more commonly. It is characterized by lymphoplasmacytic infiltration of thyroid follicular cells, hurthle cells resulting in atrophy of the follicular cells and fibrosis. Cystic change is an unusual finding in Hashimoto's thyroiditis. A 35 year old female presented as nodular goiter clinically with ultrasound showing multiple cystic areas. Histopathological examination of the specimen after thyroidectomy showed features of Hashimoto's thyroiditis with cystic areas. We report a rare case of Hashimoto's thyroiditis with cystic changes in for the first time to the best of our knowledge. A more detailed study in this regard is warranted to understand the pathogenesis of cystic changes in HT.

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INTRODUCTION

Hashimoto’s thyroiditis (HT) is an autoimmune disorder, characterized histologically by lymphoplasmacytic infiltration of thyroid follicular cells, hurthle cells resulting in fibrosis and atrophy of the cells. Cystic changes are an unusual finding in HT. We report the first case of HT with cystic changes.

CASE REPORT

A 35 year old female patient presented to our hospital with history of swelling in front of the neck from 2 years. Swelling was gradually increasing in size. There were no symptoms of hypothyroidism or hyperthyroidism in the patient. On examination there was a firm swelling with nodular surface measuring 9x6 cms. Patients pulse rate was 80/min, and BP was 120/82 mm of Hg. A clinical diagnosis of nodular goiter was made. Ultrasound showed enlargement of both lobes with multiple cystic areas with thick internal contents. Fine needle aspiration cytology of thyroid showed follicular cells in clusters, Hurthle cells with scant lymphocytic infiltration in the background of thin colloid. Diagnosis of nodular goiter was made. Thyroid function tests showed T3 162.8ngm/dl, T4 8.7µgms/dl and TSH 2.4 µIU/dl. Subtotal thyroidectomy was done. Post operatively the thyroid specimen was sent to the department of pathology. The specimen consisted of both lobes of thyroid with isthmus and was nodular. Cut section was gray white with lobular and cystic areas as in Figure 1. Histopathology showed dense lymphocytic infiltration with destruction of follicular cells. Hurthle cells, cystic areas with colloid and cyst macrophages were also seen. The cystic spaces did not have any lining epithelium as in figure 2. Immunohistochemistry showed polymorphous population of lymphocytes surrounding the follicular cells.

Figure 2: [A]- Thyroid follicles with dense lymphocytic infiltration and germinal center formation (4x). [B]- Lymphoplasmacytic infiltration with destruction of the follicles (10x). [C]- Hurthle cells with atrophic follicles with cystic space in the left upper corner (40x). [D]- Cystic spaces showing cyst macrophages and colloid with no lining epithelium (40x). Diagnosis of Hashimoto’s thyroiditis with cystic changes was made. Post-operative evaluation of the patient showed seropositivity for antithyroglobulin antibodies.

DISCUSSION

Lymphoplasmacytic infiltration of follicular cells causes atrophy of the cells with fibrosis and sclerosis. Autoimmune B and T lymphocytes along with reactive intermediates induce apoptosis and also damage the thyrocyte cell membrane causing thyrocyte necrosis1 . Cystic changes occurs in nodular goiter is due to vascular compromise, ischemia and necrosis. Cystic change can be seen in HT associated with secondary pathology like papillary carcinoma and malignant lymphoma. Matsuzuka et al reported a case of HT who developed small cyst like pattern on serial ultrasound2 . Histopathology showed features of malignant lymphoma with HT. Mitteldoff et al reported a case, seropositive for Human immunodeficiency virus (HIV) showing bilateral complex cysts with high titers of antimicrosomal antibodies. Cysts showed heterogenous

lymphocytic population and occasional groups of immature squamous cells with cytological features of autoimmune thyroiditis3 . True cysts lined by squamous epithelium, bordered by a row of lymphoid follicles in thyroid is been reported by Louis et al4 . Our case was sero-negative for HIV and the cystic spaces had no lining epithelium.

CONCLUSION

Cystic changes in HT are of rare occurrence. The lymphocytic infiltration in HT induces fibrosis rather than cystic degeneration. A case with cystic changes in HT being reported for the first time to the best of our knowledge.

RECOMMENDATIONS

A more detailed study in this regard is warranted to understand the pathogenesis of cystic change in HT.

ACKNOWLEDGEMENT

The authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. DECLARATION ON CONFLICT OF INTEREST: Nil

References:

1. Dimitry A Chistiakov. Immunogenetics of Hashimoto’s thyroiditis. Journal of Autoimmune Diseases 2005;2:1

2. FurmioMatzuzuka, Nobuyuki Amino, Kanji Kuma, Akira Miyauchi. Serial changes in thyroid ultrasonogram in a patient with Hashomoto’s thyroiditis who developed malignant lymphoma. Thyroid 2005;15(7):742- 43

3. Cristina A.T.S Mitteldorf, Antonio Carlos de OliveriaMisiara, Iara Emiko de Carvalho. Multicystic Autoimmune thyroiditis-like disease associated with HIV infection a case report. Acta cytol 1999;43:862-66

4. Multiple Branchial cleft like cysts in Hashimoto’s thyroiditis. American journal of surgi Pathol 1989;13(1)

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Best Article Award

A Study by Badritdinova MN et al. entitled "Peculiarities of a Pain in Patients with Ischemic Heart Disease in the Presence of Individual Combines of the Metabolic Syndrome" is awarded Best Article for Vol 12 issue 24
A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
A Study by Ghaffar UB et al. entitled "Correlation between Height and Foot Length in Saudi Population in Majmaah, Saudi Arabia" is awarded Best Article for Vol 12 issue 21
A Study by Leow Jun Xian and Siti Sarah Binti Maidin entitled "Sleep Well: Mobile Application to Address Sleeping Problems" is awarded Best Article for Vol 12 issue 20
A Study by Avijit Singh et al. entitled "Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma COLAKOGLU entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by Arpita M. et al entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09
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List of Awardees

Awardees of COVID-19 Research

Woman Researcher Award

A Study by Neha Garg et al. entitled "Optimization of the Response to nCOVID-19 Pandemic in Pregnant Women – An Urgent Appeal in Indian Scenario" published in Vol 12 issue 09

A Study by Sana Parveen and Shraddha Jain entitled "Pathophysiologic Enigma of COVID-19 Pandemic with Clinical Correlates" published in Vol 12 issue 13

A Study by Rashmi Jain et al. entitled "Current Consensus Review Article on Drugs and Biologics against nCOVID-19 – A Systematic Review" published in Vol 12 issue 09

Emerging Researcher Award

A Study by Madhan Jeyaraman et al. entitled "Vitamin-D: An Immune Shield Against nCOVID-19" published in Vol 12 issue 09

Study by Dheeraj Kumar Chopra et al. entitled "Lipid-Based Solid Dispersions of Azilsartan Medoxomil with Improved Oral Bioavailability: In Vitro and In Vivo Evaluation" published in Vol 12 issue 19


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