1. Practical Pathology of Thyroid

2. Case 1 A 50 yr old lady presents with a mass in anterior neck Slowly growing since 10 yr ago Soft and nodular, moves with swallowing No cervical LAD felt Rest of PE is normal

3. Work - up Thyroid hormone profile ordered : TSH : 3.5 IU/L (0.5 – 5 IU/L) T4 : 6.2 µg/dl (4.5 – 12 µg/dL) T3 : 134 ng/ dl (100 – 220 ng/dL) T3RU : 24 % (20 - 35 %)

4. Thyroid scan ordered

5. Work-up Thyroid scan ordered

6. Thyroid scan

7. Thyroid FNA performed :

10. Thyroid FNA

11. Diagnosis: Multinodular goiter Patient underwent surgery :

12. Microscopic images

18. Final diagnosis : Multinodular Goiter

19. Case 2 A 45 yr old lady presents with a lump in anterior part of neck at right thyroid lobe Slowly growing since 4 months ago The mass is firm and indiscrete, and moves with swallowing Other PEs are normal No cervical LAD is present She has Hx of Raynaud’s phenomenon

20. Thyroid hormone profile ordered : TSH: 7.2 IU/L (0.5 – 5 IU/L) T4: 4.1 µg/dl (4.5 – 12 µg/dL) T3: 105 ng/dl (100 – 220 ng/dL) 7.2

21. Thyroid FNA performed :

23. Microscopic features

27. Final diagnosis: Hashimoto’s Thyroiditis

28. Case 3 A 33 yr old man presents with firmness of his left thyroid lobe and a nodule in left cervical chain growing since 2 wks ago The latter nodule is soft The left thyroid is firm Other exams are normal

29. Next work-up step : Thyroid FNA

31. Diagnosis : Papillary carcinoma of thyroid with cervical lymph node metastasis Patient underwent total thyroidectomy and left cervical LN resection

32. Gross and microscopic features

34. microscopic features

37. Papillae, psamomma bodies

39. Final dagnosis: Papillary Carcinoma of Thyroid