Advertisement

Cytopathology in the Thyroid of Graves Disease

  • Jen-Fan HangEmail author
Chapter

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.

References

  1. 1.
    Graves RJ. Clinical lectures. Lond Med Surg J. 1835;7:516–7.Google Scholar
  2. 2.
    Burgi H. Thyroid eye disease: a historical perspective. Orbit. 2009;28(4):226–30.CrossRefGoogle Scholar
  3. 3.
    Burch HB, Cooper DS. Management of graves disease: a review. JAMA. 2015;314(23):2544–54.CrossRefGoogle Scholar
  4. 4.
    Brent GA. Clinical practice. Graves’ disease. N Engl J Med. 2008;358(24):2594–605.CrossRefGoogle Scholar
  5. 5.
    Weetman AP. Graves’ disease. N Engl J Med. 2000;343(17):1236–48.CrossRefGoogle Scholar
  6. 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.CrossRefGoogle Scholar
  7. 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.CrossRefGoogle Scholar
  8. 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.CrossRefGoogle Scholar
  9. 9.
    Carnell NE, Valente WA. Thyroid nodules in Graves’ disease: classification, characterization, and response to treatment. Thyroid. 1998;8(7):571–6.CrossRefGoogle Scholar
  10. 10.
    Belfiore A, Russo D, Vigneri R, Filetti S. Graves’ disease, thyroid nodules and thyroid cancer. Clin Endocrinol (Oxf). 2001;55(6):711–8.CrossRefGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. 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.CrossRefGoogle Scholar
  14. 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.CrossRefGoogle Scholar
  15. 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.PubMedGoogle Scholar
  16. 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.PubMedGoogle Scholar
  17. 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.CrossRefGoogle Scholar
  18. 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.CrossRefGoogle Scholar
  19. 19.
    Granter SR, Cibas ES. Cytologic findings in thyroid nodules after 131I treatment of hyperthyroidism. Am J Clin Pathol. 1997;107(1):20–5.CrossRefGoogle Scholar
  20. 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.CrossRefGoogle Scholar
  21. 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.CrossRefGoogle Scholar
  22. 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.CrossRefGoogle Scholar
  23. 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.CrossRefGoogle Scholar
  24. 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.CrossRefGoogle Scholar
  25. 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.PubMedGoogle Scholar
  26. 26.
    Friedman NB, Catz B. The reactions of euthyroid and hyperthyroid glands to radioactive iodine. Arch Pathol Lab Med. 1996;120(7):660–1.PubMedGoogle Scholar
  27. 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.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Pathology and Laboratory MedicineTaipei Veterans General HospitalTaipeiTaiwan

Personalised recommendations