Nodular thyroid disease pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pathophysiology
- Most thyroid nodules (~90%) are benign.
- Multinodular goiter accounts for 42-77%, 15-40% are follicular adenomas, 15-20% are cystic and only 6-17% are carcinomas.
- Multinodular goiters can, however, contain cancer in 1.5 – 3.6% of the cases.
- They are generally hypofunctioning, and incompletely encapsulated. Fine needle aspiration--abundant colloid and benign follicular cells.
- Follicular adenomas are usually single lesions with well-developed fibrous capsules. They are primarily classified according to size and degree of cellularity.
- Microfollicular adenomas are distinguished from carcinomas by their lack of capsular or vascular invasion. Therefore, the diagnosis of follicular CIS does not exist.
- Approximately 5% of microfollicular adenomas turn out to be malignant.
- Macrofollicular adenomas are thought not to have malignant potential.
- Microfollicular adenomas are distinguished from carcinomas by their lack of capsular or vascular invasion. Therefore, the diagnosis of follicular CIS does not exist.
- Other benign nodules include Hürthle-cell adenomas (of which 5% can turn out to be malignant), and cysts.
- Multinodular goiters can, however, contain cancer in 1.5 – 3.6% of the cases.
- Even if a nodule is malignant, differentiated thyroid cancer (papillary and follicular), account for 80% of cases, and are associated with a good prognosis.
- Sub-clinical thyroid cancer is common, with autopsy studies revealing that 6-13% of the population has occult papillary cancer.
References