272
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Grave's disease
ICD-10: E05.0
Thyroid
IgM
48 years
female
48-year-old female underwent subtotal thyroidectomy after treatment of hyperthyroidism with antithyroid drugs failed.
- Follicles are small to medium sized and irregularly formed. Colloid within the follicular lumen is scant with scalloped margins. - The epithelium is tall and columnar. Crowding of cells leads to formation of papillae, which in contrast to papillary carcinoma lack a fibrovascular core. - The inflammatory infiltrate consists of small lymphocytes, not staining for intracytoplasmic immunoglobulin. In addition, positively staining plasma cells infiltrate the septae, some aligned in chains in between follicles.
Pathogenesis: Type II hypersensitivity (antibody-mediated cellular dysfunction); agonistic antibodies targeting the TSH-receptor mimic TSH effects (TSI = thyroid stimulating immunoglobulins). Consequently, hyperplasia and hypertrophy of follicular cells ensues, leading to a usually diffuse enlargement of the thyroid (diffuse goiter). Unregulated stimulation of follicular cells to produce thyroxine (T4) and triiodthyronine (T3) leads to symptoms of hyperthyroidism.
Departement of Pathology, University of Zürich
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