THYROID PATHOLOGY
BY
BABATUNDE A. OLATIDOYE, M.D.

The thyroid is a small butterfly-shaped gland located in the front of the neck, wrapped around the windpipe just below the Adam's Apple area. It produces several hormones essential for growth, development and normal metabolism. Malfunction of the thyroid gland can be attributed to one of the following:

• imbalance of certain thyroid hormones
• inflammation of the thyroid gland
• development of a benign or malignant tumor

An imbalance in thyroid hormones can lead to several conditions. Hypothyroidism results when not enough thyroid hormone is produced and shows some of the following symptoms: brittle and dry hair, lethargy, memory impairment, puffiness of the face and eyelids, weight gain, intolerance to cold, diminished perspiration, enlarged heart, hypertension, dry skin, and slow pulse. Hypothyroidism can be treated with thyroid hormone replacement drugs. Hyperthyroidism, also known as Graves’ disease, results when the thyroid starts producing too much thyroid hormone, and shows some of the following symptoms: increased heart rate, increased blood pressure, protruding eyes, goiter, increased perspiration, shortness of breath, increased appetite, weight loss, diarrhea and tremors. Antithyroid drugs or radioactive iodine treatment known as RAI is used to treat this condition.

Thyroiditis, or inflammation of the thyroid is another malady of the gland. The most common type is known as Hashimoto’s thyroiditis. This is an autoimmune disorder that occurs more frequently in females of any age and causes hypothyroidism.

Tumors of the thyroid gland can be classified as either benign or malignant. The most common benign tumor is called adenoma and occurs more frequently in women. Malignant tumors of the thyroid gland include:

• Papillary carcinoma
• Follicular carcinoma
• Hurthle cell carcinoma
• Medullary carcinoma
• Insular carcinoma
• Anaplastic carcinoma
• Metastatic carcinoma
• Malignant lymphoma.

Thyroid cancer is fairly uncommon, accounting for only 1.2% of all new cancers in the United States annually. Survival rates are high, with 95% of all thyroid cancer patients achieving what would be considered a cure or long-term survival without reoccurrence. Papillary carcinoma is the most common and least aggressive thyroid cancer, representing over 60% of all thyroid malignant tumors. The most aggressive thyroid cancer is anaplastic carcinoma and constitutes less than 3% of thyroid malignancies. The aggressiveness of the other thyroid cancers falls between papillary and anaplastic carcinomas.

Pathologists use fine needle aspirations (FNA’s) to accurately diagnose thyroid abnormalities and disease. This involves use of a small needle to remove cells and fluid from the thyroid gland. The cells collected are then expressed onto a glass slide, smears are made and are allowed to air dry – or fixed in a fixative. The air dried slide is stained with a diff-quick stain and the fixed slide is stained with Pap stain for the pathologist to review and diagnose. Among Wilmington Pathology Associates’ six pathologists, are two board-certified cytopathologists, Babatunde A. Olatidoye, MD and Debra B. Novotny, MD, who review and diagnose the most difficult FNA biopsy cases.

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