Endocrine pathology

Question 1

Multinodular Goitre

Pathogenesis
Morphology
Clinical features

Answer 1

It stems from long standing cases of simple goitre, producing irregular enlargement of the thyroid gland.
They occur in both sporadic and endemic forms.

Pathogenesis: Uneven follicular hyperplasia.

• Long standing goitre—> some cells in a follicle undergo autonomous proliferation and form a nodule.
• Some follicles accumulate colloid even without follicular proliferation —> uneven accumulation of colloid

Follicular hyperplasia produces physical stress —> Rupture of follicle, vessels, hemorrhage, scarring and calcifications.

Morphology:
Gross- Multilobulated, assymetrically enlarged thyroid glands

Microscopy-

1) Multiple nodules containing follicles of variable sizes
2) Colloid cysts may be formed of the follicles
3) Follicular hyperplasia in some nodules
4) Fibrosis of stroma
5) Degenerative changes- Calcification, hemorrhage, hemosiderin laden macrophages

Clinical:

• Mostly asymptomatic and euthyroid
• Mass effects : Superior vena cava syndrome, hoarseness, dysphagia