Skip to main content
SpringerLink
Log in

Cytopathology in the Thyroid of Graves Disease

  • Chapter
  • First Online:
Book cover Thyroid FNA Cytology

  • 1429 Accesses

Abstract

The main role of thyroid fine needle aspiration in Patients with Graves disease is reserved for the evaluation of suspicious nodules, especially nodules showing low radioactive iodine uptake (cold nodules). In addition to neoplastic nodules, there are several nonneoplastic causes for nodularity, including coexisting adenomatous/colloid goiter, pseudonodules of lymphocytic infiltrate, and reactive/degenerative changes. Therefore, to evaluate the nature of thyroid nodules arising from patients with Graves disease is crucial for the clinical management. In fine needle aspiration, it is possible to sample the nonlesional tissue adjacent to the nodule. In addition to the diffuse hyperplastic changes, cytologic atypia is common in patients previously treated with antithyroid drugs or radioactive iodine. For these reasons, the interpretation of fine needle aspiration in Graves disease has been considered one of the most challenging tasks in thyroid cytopathology. In this chapter, we discuss the thyroid cytopathologic characteristics in Graves disease, particularly changes related to treatment as well as the diagnostic criteria of malignancy in this setting.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 299.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 379.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Graves RJ. Clinical lectures. Lond Med Surg J. 1835;7:516–7.

    Google Scholar 

  2. Burgi H. Thyroid eye disease: a historical perspective. Orbit. 2009;28(4):226–30.

    Article  Google Scholar 

  3. Burch HB, Cooper DS. Management of graves disease: a review. JAMA. 2015;314(23):2544–54.

    Article  CAS  Google Scholar 

  4. Brent GA. Clinical practice. Graves’ disease. N Engl J Med. 2008;358(24):2594–605.

    Article  CAS  Google Scholar 

  5. Weetman AP. Graves’ disease. N Engl J Med. 2000;343(17):1236–48.

    Article  CAS  Google Scholar 

  6. Bahn Chair RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011;21(6):593–646.

    Article  Google Scholar 

  7. Sundaresh V, Brito JP, Wang Z, Prokop LJ, Stan MN, Murad MH, et al. Comparative effectiveness of therapies for Graves’ hyperthyroidism: a systematic review and network meta-analysis. J Clin Endocrinol Metab. 2013;98(9):3671–7.

    Article  CAS  Google Scholar 

  8. Wartofsky L, Glinoer D, Solomon B, Nagataki S, Lagasse R, Nagayama Y, et al. Differences and similarities in the diagnosis and treatment of Graves’ disease in Europe, Japan, and the United States. Thyroid. 1991;1(2):129–35.

    Article  CAS  Google Scholar 

  9. Carnell NE, Valente WA. Thyroid nodules in Graves’ disease: classification, characterization, and response to treatment. Thyroid. 1998;8(7):571–6.

    Article  CAS  Google Scholar 

  10. Belfiore A, Russo D, Vigneri R, Filetti S. Graves’ disease, thyroid nodules and thyroid cancer. Clin Endocrinol (Oxf). 2001;55(6):711–8.

    Article  CAS  Google Scholar 

  11. Cantalamessa L, Baldini M, Orsatti A, Meroni L, Amodei V, Castagnone D. Thyroid nodules in Graves disease and the risk of thyroid carcinoma. Arch Intern Med. 1999;159(15):1705–8.

    Article  CAS  Google Scholar 

  12. Kraimps JL, Bouin-Pineau MH, Mathonnet M, De Calan L, Ronceray J, Visset J, et al. Multicentre study of thyroid nodules in patients with Graves’ disease. Br J Surg. 2000;87(8):1111–3.

    Article  CAS  Google Scholar 

  13. Gerenova J, Buysschaert M, de Burbure CY, Daumerie C. Prevalence of thyroid cancer in Graves’ disease: a retrospective study of a cohort of 103 patients treated surgically. Eur J Intern Med. 2003;14(5):321–5.

    Article  CAS  Google Scholar 

  14. Kim WB, Han SM, Kim TY, Nam-Goong IS, Gong G, Lee HK, et al. Ultrasonographic screening for detection of thyroid cancer in patients with Graves’ disease. Clin Endocrinol (Oxf). 2004;60(6):719–25.

    Article  Google Scholar 

  15. Smejkal V, Smejkalova E, Rosa M, Zeman V, Smetana K. Cytologic changes simulating malignancy in thyrotoxic goiters treated with carbimazole. Acta Cytol. 1985;29(2):173–8.

    CAS  PubMed  Google Scholar 

  16. Jayaram G, Singh B, Marwaha RK. Grave’s disease. Appearance in cytologic smears from fine needle aspirates of the thyroid gland. Acta Cytol. 1989;33(1):36–40.

    CAS  PubMed  Google Scholar 

  17. Oz F, Urgancioglu I, Uslu I, Dervisoglu S, Oz B, Kanmaz B. Cytologic changes induced by 131I in the thyroid glands of patients with hyperthyroidism; results of fine needle aspiration cytology. Cytopathology. 1994;5(3):154–63.

    Article  CAS  Google Scholar 

  18. Centeno BA, Szyfelbein WM, Daniels GH, Vickery AL Jr. Fine needle aspiration biopsy of the thyroid gland in patients with prior Graves’ disease treated with radioactive iodine. Morphologic findings and potential pitfalls. Acta Cytol. 1996;40(6):1189–97.

    Article  CAS  Google Scholar 

  19. Granter SR, Cibas ES. Cytologic findings in thyroid nodules after 131I treatment of hyperthyroidism. Am J Clin Pathol. 1997;107(1):20–5.

    Article  CAS  Google Scholar 

  20. Sturgis CD. Radioactive iodine-associated cytomorphologic alterations in thyroid follicular epithelium: is recognition possible in fine-needle aspiration specimens? Diagn Cytopathol. 1999;21(3):207–10.

    Article  CAS  Google Scholar 

  21. Anderson SR, Mandel S, LiVolsi VA, Gupta PK, Baloch ZW. Can cytomorphology differentiate between benign nodules and tumors arising in Graves’ disease? Diagn Cytopathol. 2004;31(1):64–7.

    Article  Google Scholar 

  22. Hang JF, Lilo MT, Bishop JA, Ali SZ. Diagnostic accuracy of fine needle aspiration in thyroid nodules arising in patients with graves disease. Acta Cytol. 2017;61(2):117–24.

    Article  Google Scholar 

  23. Das DK. Marginal vacuoles (fire-flare appearance) in fine needle aspiration smears of thyroid lesions: does it represent diffusing out of thyroid hormones at the base of follicular cells? Diagn Cytopathol. 2006;34(4):277–83.

    Article  Google Scholar 

  24. Kennedy JS, Thomson JA. The changes in the thyroid gland after irradiation with 131I or partial thyroidectomy for thyrotoxicosis. J Pathol. 1974;112(2):65–81.

    Article  CAS  Google Scholar 

  25. Mizukami Y, Michigishi T, Nonomura A, Hashimoto T, Noguchi M, Ohmura K, et al. Histologic changes in Graves’ thyroid gland after 131I therapy for hyperthyroidism. Acta Pathol Jpn. 1992;42(6):419–26.

    CAS  PubMed  Google Scholar 

  26. Friedman NB, Catz B. The reactions of euthyroid and hyperthyroid glands to radioactive iodine. Arch Pathol Lab Med. 1996;120(7):660–1.

    CAS  PubMed  Google Scholar 

  27. Pellegriti G, Mannarino C, Russo M, Terranova R, Marturano I, Vigneri R, et al. Increased mortality in patients with differentiated thyroid cancer associated with Graves’ disease. J Clin Endocrinol Metab. 2013;98(3):1014–21.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Jen-Fan Hang

Authors
  1. Jen-Fan Hang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jen-Fan Hang .

Editor information

Editors and Affiliations

  1. Faculty of Medicine, Nara Hospital, Kindai University, Ikoma, Japan

    Kennichi Kakudo

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Singapore Pte Ltd.

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Hang, JF. (2019). Cytopathology in the Thyroid of Graves Disease. In: Kakudo, K. (eds) Thyroid FNA Cytology. Springer, Singapore. https://doi.org/10.1007/978-981-13-1897-9_54

Download citation

  • DOI: https://doi.org/10.1007/978-981-13-1897-9_54

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-13-1896-2

  • Online ISBN: 978-981-13-1897-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation