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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Histomorphological Study of Thyroid Lesions in Autopsy Specimens: A Cross-sectional Study
Correspondence Address :
Dr. Parvathi S Jigalur,
Associate Professor, Department of Pathology, Karnataka Institute of Medical Sciences, Hubballi-580022, Karnataka, India.
E-mail: mithraasekar@gmail.com
Introduction: The thyroid gland has been the subject of intense research and considerable attention due to the broad spectrum of diseases, ranging from functional and immunologically mediated enlargements to neoplastic lesions. Pathology within the endocrine system is not commonly found at autopsy, and when identified, it is even less frequently the cause of death. Studying asymptomatic thyroid lesions in living individuals is complex, making an autopsy study the best approach for this purpose. The data collected during the study can provide valuable insights for future epidemiological and clinical studies.
Aim: To examine the histomorphological features and spectrum of thyroid lesions in autopsy specimens.
Materials and Methods: The present study was a descriptive cross-sectional and prospective study carried out on the 140 autopsy specimens of the entire thyroid gland, dissected from deceased individuals during post-mortem examinations conducted in the Department of Pathology, at the Karnataka Institute of Medical Sciences (KIMS), Hubballi, Karnataka, India, from 1 November 2016 to 31 October 2017. The study examined the histomorphological features and spectrum of thyroid lesions in autopsy specimens. The statistical analysis was carried out using Statistical Packages for Social Sciences (SPSS) software version 14.0.
Results: A total of 140 autopsy specimens of the whole thyroid gland were included during the study period. The age of the patients ranged from 18 to 68 years. The mean weight of the thyroid gland was 19.24 grams (minimum 10 grams and maximum 50 grams). The peak incidence of thyroid diseases was observed in the fourth to fifth decades of life. Thyroid disease was predominantly seen in females compared to males, with a male-to-female ratio of 1:4.7. In present study, 90 cases (64.3%) were normal; 49 cases (35.0%) were non neoplastic lesions; and 1 case (0.7%) was classified as a neoplastic lesion. Goitre 34 (67.4%) cases was the most common non neoplastic lesion, followed by Hashimoto’s thyroiditis 9 (18.4%) cases. Other less commonly encountered non neoplastic lesions included lymphocytic thyroiditis 4 (8.2%) cases, primary hyperplasia 1 (2%) case, Reidel’s thyroiditis 1 (2%) case, and thyroglossal cyst 1 (2%) case. Only one neoplastic lesion was observed, which was papillary microcarcinoma of the conventional type, accounting for 0.7% of the cases studied.
Conclusion: The present study provided data regarding the distribution of different types of thyroid pathologies in autopsy specimens in the North Karnataka region. Although females constituted only 42.1% of the study population, a higher proportion of females exhibited various diagnostic pathological lesions. These incidental lesions indicate the burden of thyroid lesions in that region, which could have been detected through routinely available screening tests for thyroid conditions.
Autopsy specimens of thyroid, Non neoplastic lesions, Papillary microcarcinoma
The thyroid gland plays a wide range of physiological roles in the body, making it unique among other endocrine organs. The hormones released from the thyroid gland affect all body organs and help maintain homeostasis and bodily integrity (1). Among all the endocrine disorders, thyroid disorders are the most common in India (2). The thyroid gland has been the subject of intense research and considerable attention due to the broad spectrum of diseases, ranging from functional and immunologically mediated enlargements to neoplastic lesions. Although chronic thyroid diseases have become a significant global cause of morbidity and mortality, literature is scarce regarding the burden of chronic thyroid diseases in Southern India. These disorders can manifest as either hyperthyroidism or hypothyroidism, or as mass lesions (3). The enlargements may sometimes be diffuse or nodular, causing noticeable physiological changes. In contrast, patients with papillary carcinoma of the thyroid with secondaries in lymph nodes may remain asymptomatic until a very late stage (4). Thyroid cancer is the most common endocrine malignancy (5).
Pathology within the endocrine system is not frequently found at autopsy, and when identified, it is even less commonly the cause of death. Nevertheless, the examination of the endocrine system is part of any thorough post-mortem examination and occasionally produces surprises, particularly on histological examination. Studying asymptomatic thyroid lesions in living individuals is a difficult task, and autopsy studies provide the best possible way to investigate these lesions. The data collected during such studies can provide valuable insights for future epidemiological and clinical studies. The present study was undertaken to investigate the histomorphological features and spectrum of thyroid lesions in autopsy specimens.
The present study was a descriptive cross-sectional and prospective study carried out on autopsy specimens of the entire thyroid gland, which were dissected from deceased individuals during post-mortem examinations at the Karnataka Institute of Medical Sciences (KIMS), Hubballi, Karnataka, India. The specimens were received in the Department of Pathology, KIMS, Hubballi, from November 1, 2016, to October 31, 2017, adhering to the inclusion criteria established for the study. Ethical clearance was obtained from RGUHS, Bengaluru, Karnataka, with the reference number 01_M012_72709.
Inclusion criteria: All autopsy specimens of the entire thyroid gland were taken from adults aged 18 years and above were included in the study.
Exclusion criteria:
• Putrefied and decomposed bodies.
• Cases of death due to compression of the neck.
• Thyroid-related causes of death.
• Special cases (custodial deaths, assaults, murder cases).
• Railway accidents.
• Autolysed specimens of the thyroid.
• Individuals aged below 18 years.
Study Procedure
After adequate fixation using 10% neutral buffered formalin, the specimens were subjected to gross examination and were sectioned serially. A single section from each lobe of the thyroid and the isthmus was sampled in grossly normal thyroid specimens. If any lesions were identified, grossly adequate representative areas were sampled, with a minimum of three sections taken from the lesion proper. Tissue processing was performed according to standard protocols, after which paraffin-embedded sections of 5μ thickness were cut and stained with Haematoxylin and Eosin (H&E) stain. Stained slides were studied under a microscope and diagnosed based on histopathological findings.
Statistical Analysis
The statistical analysis was carried out using Statistical Packages for Social Sciences (SPSS) software (version 14.0). Descriptive analysis was performed using frequencies and percentages.
During the study period, considering the inclusion and exclusion criteria, 140 autopsy specimens of the entire thyroid gland were included in the study, all of whom had no clinical history of thyroid disease. Males constituted 81 (57.9%) and females 59 (42.1%), resulting in a male-to-female ratio of 1.4:1. The mean age of the study participants was 40 years, with a minimum age of 18 years and a maximum age of 68 years.
The mean weight of the thyroid gland was 19.24 grams, with a minimum of 10 grams and a maximum of 50 grams, and a Standard Deviation (SD) of 8.413 grams. The mean weight of the gland was 17.32±6.13 g in males and 21.86±10.28 g in females.
Histologically, thyroid lesions were broadly categorised into normal, non neoplastic, and neoplastic lesions. Normal thyroid specimens contributed to the majority of the autopsy specimens. Non neoplastic lesions were more common than neoplastic lesions. The frequency of various non neoplastic and neoplastic lesions is provided in (Table/Fig 1).
Out of 140 cases, 90 (64.3%) were normal, 49 (35.0%) were non neoplastic, and 1 (0.7%) was neoplastic. The most common non neoplastic lesion was goitre, accounting for 34 (24.3%) of the cases studied, followed by thyroiditis at 14 (10.0%). One intrathyroidal thyroglossal cyst was observed, accounting for 0.7% of the patients studied. In present study, only one neoplastic lesion was identified: a papillary microcarcinoma, which accounted for 0.7% of the cases studied.
The spectrum of various non neoplastic lesions included adenomatous goitre, which accounted for 67.4%, followed by Hashimoto’s thyroiditis at 18.4% and lymphocytic thyroiditis at 8.2%. Other types of lesions included primary hyperplasia, Reidel’s thyroiditis, and thyroglossal cysts. Most cases of goitre and thyroiditis were distributed among the age group of 31-40 years. (Table/Fig 2) shows the histomorphological spectrum of lesions according to age group. Goitre and thyroiditis were more commonly observed in females than in males. The histomorphological spectrum of lesions according to gender has been depicted in (Table/Fig 3).
Non Neoplastic Lesions
Adenomatous goitre: Adenomatous goitre is the most common non neoplastic lesion, accounting for 67.4% of non neoplastic lesions. The male-to-female ratio is 0.4:1. Among 33 cases, nodular goitre comprised 30 (90.9%) cases and colloid goitre 3 (9.1%) cases. Nodularity was observed on the cut surface in 30 cases. The minimum and maximum sizes of the nodules were 0.8 cm and 2.5 cm, respectively, with a mean size of 1.532 cm in diameter and a standard deviation of 0.4792 cm. The cut surface of the gland revealed colloid-filled areas appearing as brown, glassy, and translucent in 24 cases, while nine patients exhibited colloid-filled areas alongside tan-white areas, resulting in a variegated appearance (Table/Fig 4)a.
Microscopically, the lesions showed follicles arranged in varying sizes, consisting of macro, micro, normofollicles, and cystic follicles (Table/Fig 4)b. The follicles were filled with variable amounts of colloid, ranging from abundant to moderate to scant (Table/Fig 4)c. Most follicles were predominantly lined by cuboidal cells, followed by flattened and columnar cells. These cells exhibited moderate eosinophilic to amphophilic cytoplasm and round to oval nuclei. Cystic changes were noted in three cases, and hyperplastic adenomatous nodules were present in 10 patients. The smallest nodule measured 1 cm, while the largest was 2.5 cm in diameter (Table/Fig 4)d. All lesions exhibited incomplete to complete irregularly thick reactive fibrous walls, and the adjacent thyroid demonstrated features of adenomatous goitre in all cases. Incomplete fibrous walls were observed in two patients, while entirely irregularly thick fibrous walls were seen in eight cases (Table/Fig 5)a,b.
Focal dense lymphocytic aggregates, suggesting an association with lymphocytic thyroiditis, were noted in two cases. In one case, lymphoid follicles with germinal centre formation, focal destruction of follicles, and Hürthle cell change were identified, indicating an association with Hashimoto’s thyroiditis. Additionally, 11 cases showed scattered lymphocytic infiltrates, and one case exhibited acute inflammatory cell infiltrate in the stroma.
The most common stromal change observed was fibrosis, which was present in all cases. Congestion and haemorrhage were also seen in most cases.
Thyroiditis: In present study, 14 cases (10%) of thyroiditis were observed, accounting for 28.6% of non neoplastic lesions. The male-to-female ratio was 0.7:1. Among the cases of thyroiditis, Hashimoto’sthyroiditis was the most common, followed by lymphocytic thyroiditis, with one case of Reidel’s thyroiditis also noted.
Hashimoto’s thyroiditis was the second most common non neoplastic lesion, constituting 64.3% (9 cases) and 18.4% of neoplastic lesions. Three cases occurred in males, while six cases were reported in females. Most cases were observed in the age group of 31-40 years. Among these cases, 8 (88.9%) were of the classic type, and 1 (11.1%) was of the nodular type of Hashimoto’s thyroiditis (Table/Fig 6)a. In addition to these nine cases, one case was seen in association with adenomatous goitre. Grossly, eight cases exhibited a lobular surface, while one case showed nodularity. The cut surface of all cases was diffusely tan-yellow to tan-white.
Microscopically, the follicular cells were predominantly cuboidal and flattened, with round to oval nuclei, delicate chromatin, and a moderate amount of cytoplasm. The follicles varied in size. All cases exhibited Hurthle cell change, characterised by abundant eosinophilic granular cytoplasm, vesicular nuclei, and prominent nucleoli. Moderate amounts of colloid were observed in most cases. All cases showed minimal stromal fibrosis. Dense lymphocytic infiltrates were seen in eight patients, and germinal centre formation was observed in one case. All cases displayed plasma cell infiltration and destruction of the follicles (Table/Fig 6)b-d.
Chronic (focal) lymphocytic thyroiditis constituted 4 (28.6%) cases of thyroiditis cases and 8.2% of non neoplastic lesions. In two cases, the cut surface of the gland appeared unremarkable, while the other two patients exhibited tan-yellow to tan-white areas. Microscopically, all four cases showed dense lymphocytic aggregates. In addition to these cases, two were seen in association with nodular goitre. In all these cases, there was no associated stromal fibrosis, oncocytic cytoplasmic change, or follicular cell atrophy, except in two cases associated with nodular goitre, which exhibited stromal fibrosis.
In present study, one case of Reidel’s thyroiditis was diagnosed, accounting for 7.1% of thyroiditis cases and 2.0% of non neoplastic lesions. It was observed in a 38-year-old female. Grossly, the gland exhibited a firm to hard consistency; the external surface showed an opaque, thickened capsule, and the cut surface was tan-white with fibrosis. Microscopically, the parenchyma was replaced by dense fibrosis, with remnants of thyroid follicles present. Fibrosis was more prominent in the isthmus, leading to the entrapment of the follicles within the collagen. Chronic inflammatory cell infiltrates were noted (Table/Fig 7)a,b.
Primary hyperplasia/diffuse toxic goitre: one instance was documented in present study, accounting for 2.0% of non neoplastic lesions and 2.9% of goitre cases. The present case involved a 38-year-old female. Grossly, the gland weighed 40 grams and showed diffuse symmetrical enlargement. The cut surface appeared diffusely tan-yellow to tan-white with a lobulated appearance.
Microscopically, follicular cells were arranged in normofollicles, macrofollicles, and a few areas exhibited papillary arrangements. The cells were cuboidal to columnar, with abundant amphophilic cytoplasm, round to oval nuclei, and coarse chromatin in some areas. A moderate amount of colloid was present, with scalloping of the colloid observed. There were dense lymphocytic infiltrates with areas of germinal centre formation, and the stroma showed congested blood vessels (Table/Fig 8)a,b.
Thyroglossal cyst: Regarding the thyroglossal cyst, one case of an intrathyroidal thyroglossal cyst was identified in present study, accounting for 2.0% of non neoplastic lesions. This case involved a 45-year-old male. The cut surface revealed a cyst in the left lobe measuring 1.5 cm in diameter; the cyst was smooth-walled and contained colloid. Microscopically, the cyst wall was lined by columnar epithelium, while the rest of the thyroid gland appeared unremarkable.
Neoplastic Lesion
Papillary carcinoma: One case of papillary microcarcinoma, a conventional type, was observed in this study, accounting for 0.7% of the total cases. It was seen in a 30-year-old female; grossly, the lesion was not visible. Microscopically, a non encapsulated tumour arranged in a papillary pattern was identified. The tumour cells exhibited round to oval nuclei, dispersed chromatin, and moderate eosinophilic cytoplasm. Features such as nuclear crowding, overlapping, Orphan Annie nuclei, and nuclear grooves were noted (Table/Fig 9)a,b.
Other Microscopic Findings
Focal lymphocytic infiltration: Focal non specific lymphocytic infiltration was observed in 13 (14.4%) cases of the normal thyroid tissue, with four patients being female and nine male.
Parathyroid: In present study, eight cases involved the parathyroid glands, accounting for 5.7% of the total cases. In 5 (3.6%) patients, the parathyroid gland was found extrathyroidally, while in 3 (2.1%), it was located intrathyroidally. One of the five cases with an extrathyroidal parathyroid gland showed microscopic features consistent with parathyroid adenoma.
The true prevalence and nature of thyroid lesions are not documented in the North Karnataka region, and autopsy studies can provide insights into the prevalence of thyroid disease in the community. The morphology of the thyroid gland in autopsy specimens was characterised in this study. In the present study, out of 140 cases, 90 (64.3%) cases were normal, while another study conducted in Kolkata by Das MM et al., reported an incidence of 54.6% (6). Other studies have reported data varying from 28% to 73.1% for normal thyroids.
The variation in the incidence of normal thyroids among various studies is likely due to differences in the methodology of thyroid examination, variations in the range of alterations that define an abnormal gland, and demographic differences.
In present study, the mean weight of the thyroid gland was 19.24 grams (with a minimum of 10 grams and a maximum of 50 grams) and a standard deviation of 8.413 grams. The mean weight of the gland was 17.32±6.13 g in males and 21.86±10.28 g in females. The mean weight of the thyroid gland in males was comparable to that found in the Indian study conducted by Harjeet A et al., (15.01±7.69 g) (7). However, the mean weight was less compared to other studies conducted by Das MM et al., (30.57 g) (6). The mean weight of the thyroid gland in females was comparable to a Turkish study (21.93±7.98 g) (8).
The mean weight was higher compared to another study by Harjeet A et al., (13.16±5.64 g), but lower compared to the study conducted by Das MM et al., which reported a mean weight of 39.43 g (6),(7).
Non neoplastic Lesions
In present study, out of 140 cases, 90 (64.3%) patients were normal, 49 (35.0%) cases were non neoplastic, and 1 (0.7%) case was neoplastic.
Adenomatous goitre: In the present study, adenomatous goitre was the most common non neoplastic lesion, accounting for 67.4% of non neoplastic lesions and 23.6% of all the cases studied. In an Indian study conducted by Das MM et al., the incidence was 20.0%, which does not align with the findings of the present study; this discrepancy may be attributed to demographic variations (6). Other studies have reported incidences ranging from 7.8% to 50.0% for adenomatous goitre. (Table/Fig 4) compares the distribution of adenomatous goitre and thyroiditis in the present study with that of various other studies.
According to the World Health Organisation (WHO), the upper limit of the weight of a normal gland is 40 grams; however, several studies suggest that a gland weighing more than 35 grams is considered goitrous. In this study, 66.7% of the cases that were histologically proven goitre weighed less than 35 grams. The incidence of diffuse colloid goitre in the present study was 2.1% of the total cases studied and 9.1% among those with adenomatous goitre. Other studies have reported data ranging from 3.3% to 14.3% for diffuse colloid goitre.
Thyroiditis: In present study, 14 cases (10%) of thyroiditis were observed, accounting for 28.6% of non neoplastic lesions. In an Indian study conducted by Das MM et al., the incidence was reported to be 17.5%, which does not align with the findings of the present study (6). Other studies reported varying incidences of thyroiditis ranging from 1.3% to 29.6% (Table/Fig 10) (6),(9).
• Autoimmune thyroiditis: According to "Rosai and Ackerman’s Surgical Pathology," autoimmune thyroiditis is characterised by extensive lymphocytic infiltration of the gland, which is associated with germinal centre formation (10). The appearance of the intervening follicles typically determines the category to which a given case belongs: In Grave’s disease, the follicles are diffusely hyperplastic; lymphocytic thyroiditis exhibits relatively normal follicles; and in Hashimoto’s thyroiditis, the follicles are lined by cells showing extensive oncocytic change. Autoimmune thyroiditis includes Hashimoto’s thyroiditis, lymphocytic thyroiditis, and Grave’s disease (10).
The present study identified autoimmune thyroiditis in 16 cases, comprising seven males and nine females. The histological features suggestive of lymphocytic thyroiditis were noted in five cases, two of which were associated with nodular goitre, while Hashimoto’s thyroiditis was identified in ten cases, with one case also associated with adenomatous goitre. Additionally, one case demonstrated features of Grave’s disease.
Scopa CD et al., studied thyroid glands obtained from 120 autopsies and found thyroiditis in 9% of cases, of which Hashimoto’s thyroiditis was seen in 2.5%. Lymphocytic thyroiditis was observed in 7% of cases; of these, six cases were isolated, and two cases were associated with goitre (11). In a study conducted by Das MM et al., in Kolkata, Hashimoto’s thyroiditis was seen in four cases (1.7%), and lymphocytic thyroiditis was seen in 18 cases (7.5%) (6). Although autopsy studies regarding autoimmune thyroiditis in India are scarce, a cross-sectional, multicentric epidemiological study was conducted in eight major cities (Bengaluru, Chennai, New Delhi, Goa, Mumbai, Hyderabad, Ahmedabad, and Kolkata) to examine the prevalence of hypothyroidism among the adult population. Antithyroid peroxidase antibodies suggesting autoimmunity were detected in 21.85% (n=1171) of patients (12).
• Reidel’s thyroiditis: In present study, non neoplastic lesion, such as Reidel,s thyroiditis (0.7%) were observed. Reidel’s thyroiditis is a rare disease with a reported prevalence of 0.06% to 0.3%, affecting women more than men, and primarily occurring in adults (6). In the present study, there was only one case of Reidel’s thyroiditis, which accounted for 0.7% of the total cases; this case was seen in a 38-year-old female.
Thyroglossal cyst: An intra-thyroid thyroglossal cyst in an adult is an unusual finding. The present study identified an intra-thyroid thyroglossal cyst in a 45-year-old male, which also accounted for 0.7% of the total cases.
Neoplastic Lesions
In present study, only one neoplastic lesion was observed: papillary microcarcinoma, the conventional type, accounting for 0.7% of the cases studied. In a study conducted by Das MM et al., in Kolkata, the incidence was reported to be 5%, which does not align with the findings of the present study (6). Other studies have reported data varying from 5% to 37.1% for neoplastic lesions.
In the present study, no benign neoplasms or metastatic lesions were found. In an Indian study by Das MM et al., there were no metastatic lesions to the thyroid; however, benign lesions were present (8). No benign neoplastic lesions were seen in present study. In contrast, various studies have documented benign lesions, with the most common being follicular adenoma, as reported by Das MM et al., Fadesewa O et al., and Menderico GM et al., (6),(9),(13).
Only one primary malignant lesion was seen in this study, accounting for 0.7% of the cases. In Das MM et al., study in Kolkata, the incidence of primary malignant lesions was 2.5%, which does not agree with the present findings (Table/Fig 11) (6),(9),(13).
The frequency of thyroid microcarcinomas varies from 1% to 35.6%. This wide range of incidence can be attributed to different methods of pathological examination, as well as epidemiological and environmental factors. In our study, the incidence of microcarcinoma was 0.7%, being the only malignant lesion identified. Most thyroid microcarcinomas are papillary carcinomas, although other histologic types can be rarely observed.
The low incidence of malignant lesions in present study may be attributed to the possibility that microcarcinoma foci could be missed, especially since, the thyroid gland appeared grossly normal. Additionally, in a study by Scopa CD et al., five of the seven microcarcinomas were not macroscopically visible, and two were found in goitrous thyroids (10).
Other Microscopic Findings
Parathyroid: The thyroid usually develops in conjunction with pharyngeal or branchial pouches, so derivatives of these structures can sometimes be observed in the thyroid. In our study, eight cases showed parathyroid glands, accounting for 5.7% of the cases. In 5 (3.6%) cases, the parathyroid gland was located extrathyroidally, while in 3 (2.1%) patients, the gland was found intrathyroidally. Various authors have estimated that the actual occurrence of intrathyroidal parathyroid tissue is 0.2% (14). In a study conducted by Scopa CD et al., the incidence was 6% (11).
Focal lymphocytic infiltration: The study noted focal lymphocytic infiltration in 13 cases (14.4%). These cases did not conform to the morphological diagnosis of autoimmune thyroiditis. Focal non specific collections of lymphocytes are observed at autopsy in the thyroids of about one-half of females and one-fourth of males; this finding is regarded as a subclinical manifestation of focal lymphocytic thyroiditis (10). In a study by Das MM et al., in Kolkata, focal lymphocytic infiltration was observed in 20 cases (8%) (6).
Limitation(s)
The sample size is small, and the number of neoplastic lesions in the present study is limited. A more extensive study population is required from different institutions to compile comprehensive data on thyroid lesions. Exact clinical details regarding the thyroid status of these cases were not available, as they were autopsy cases. The cause of death was not available for all patients. In comparison to the general population, the present study has limitations, including a small sample size and a predominance of the male population. However, the findings from gross examination and microscopy, along with adequate postmortem examination, can help us understand the variations in the normal and natural course of diseases in the thyroid gland.
The present study provides data regarding the distribution of different types of thyroid pathologies in autopsy specimens from the North Karnataka region. Although females constituted only 42.1% of the study population, they exhibited a higher percentage of various diagnostic pathological lesions, such as adenomatous goitre, thyroiditis, and conventional-type papillary microcarcinoma. These incidental lesions suggest that there could be a significant burden of thyroid lesions in our region that might have been detected through routine screening tests available for thyroid conditions.
DOI: 10.7860/JCDR/2024/63997.20342
Date of Submission: Apr 17, 2023
Date of Peer Review: Jun 10, 2023
Date of Acceptance: Aug 29, 2023
Date of Publishing: Nov 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Apr 19, 2023
• Manual Googling: Jun 12, 2023
• iThenticate Software: Aug 28, 2024 (14%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com