Pathology of thyroid

Pathology of thyroid 

Updated: 01/25/2023

© Jun Wang, MD, PhD

Anatomy/histology
  • Two lobes connected by isthmus
  • Superior laryngeal nerve
Accompanies to superior thyroid artery
Injury may occur due to thyroidectomy
External branch: motor control cricothyroid muscle, injury causes loss of high pitch voice
Internal branch: laryngeal sensation, injury causes loss of sensation and cough
  • Recurrent laryngeal nerve
Accompanies to inferior thyroid artery
Injury may occur due to thyroidectomy
Innervate all laryngeal muscle except cricothyroid muscle
Injury causes subacute vocal cord paralysis and postoperative hoarseness or breathiness
  • Parathyroid glands
Close to posterior surface of thyroid lobes
Injury may occur due to thyroidectomy
Injury causes hypoparathyroidism, hypocalcemia
  • Follicles
Flat to cuboid cells with small round nuclei
Homogenous colloid containing thyroblobulin
  • C cells:
Parafollicular cells
Produce calcitonin
Physiology
  • Thyroid stimulating hormone (TSH)
Secreted by pituitary
Promote thyroid hormone production
Most sensitive marker for thyroid function
  • Thyroid hormone
Cleaved from iodinized thyroglobulin to form T3 and T4
Promote metabolism, inhibit TSH secretion
Commonly used thyroid function tests
  • Thyroid-stimulating hormone (TSH): Most useful single screening test for hyperthyroidism
  • Thyroid hormones: Free thyroxine (FT4) or free thyroxine index (FTI—total T4 multiplied by serum binding correction factor), total triiodothyronine (T3)
  • Autoantibody tests: anti-thyroid peroxidase (anti-TPO), thyroid stimulating immunoglobulin

Functional disorders

Graves disease
Thyroid storm
Apathetic hyperthyroidism

Goiter
Inflammatory disorders
Neoplasm of thyroid glands
Papillary carcinoma
Follicular carcinoma
Anaplastic carcinoma
Medullary carcinoma

Practice question I
Practice question II
Practice question III

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