Heterogenous morphologic forms of goiter in autoimmune thyroid disease: An insight based on a prospective surgical series of 88 cases

Abstract

Two commonest forms of autoimmune thyroid disease (AITD) are Graves’ disease (GD) and Hashimoto’s thyroiditis (HT) with a diffuse goiter. The nature of goiter apart from clinical presentation is crucial in the management of AITD. But, the goiter is not always diffuse, leading to diagnostic confusion. In this context, we conducted a prospective study on the goiter morphology in AITD. This is a prospective study conducted in Endocrine Surgery department of a teritiary care teaching hospital in South India over a period of 1 year. The cohort is a surgical series of 88 cases of AITD (GD = 53; HT = 35). Morphology of all the ex vivo specimens were studied, documented and correlated with clinical and radiological forms of goiter. Sex ratio was M:F = 74:14. Mean age for GD = 30.7 years (17-46) and HT = 38.2 years (31-52). In GD, the morphology was diffuse = 34; Unilateral hyperplasia (ULH) = 9; atrophic = 4; nodular = 5 and Marine Lenhart syndrome = 1. In HT, diffuse = 16; ULH = 10 and nodular goiter = 9. The correlation between the radiology and goitrous morphology was statistically significant and more concordant than clinico-morphological correlation. Autoimmune thyroid disease has heterogenous goitrous forms. Macroscopic morphological evaluation of goiter complements the clinicoradiological-pathological diagnosis of AITD leading to optimal diagnosis, counseling, follow-up.