Cytologic Findings in Thyroid Nodules After¹³¹I Treatment of Hyperthyroidism

Abstract

Findings in seven cytologic specimens obtained with fineneedle aspiration biopsy were described in three patients in whom thyroid nodules developed after iodine 131 treatment of hyperthyroidism. In two patients, the presence of large bizarre cells with hyperchromatic nuclei, coarse chromatin, and prominent nucleoli suggested the possibility of malignancy, and in particular, anaplastic carcinoma. These bizarre nuclear changes were diffuse in one patient and focal in the other. In the third patient, nuclei with chromatin clearing, grooves, and nuclear pseudoinclusions suggested papillary carcinoma. At follow-up, lesions Systemic administration of low doses of iodine 131 is a common treatment for hyperthyroidism. The histologic features induced by therapeutic irradiation of the thyroid gland have been described 1-5 and include chronic inflammation, fibrosis, and Hiirthle cell metaplasia. In addition, the development of nodular hyperplasia with marked cytologic atypia may lead to a misdiagnosis of malignancy, particularly if a clinical history of radiation therapy is not provided. In contrast to the ample histologic descriptions, little literature is available regarding the cytologic changes associated with irradiation of the thyroid gland. We describe the cytologic findings of thyroid nodules that developed in three patients after 131 I therapy. MATERIALS AND METHODSThe cytology files at Brigham and Women's Hospital, Boston, were searched for cases of fine-needle aspiration biopsy (FNA) of the thyroid gland in patients with a history of 131 I therapy. All available cytology and surgical pathology slides in such cases were reevaluated. Records were reviewed for pertinent clinical information and follow-up data. Cytologic Cytology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. Manuscript received July 22,1966; accepted July 24,1996. Address reprint requests to Dr Granter: Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. were benign in all three patients. We conclude that nuclear changes suggestive of either anaplastic carcinoma or papillary carcinoma may be seen in thyroid nodules after , 3 1 I treatment. Clues to the benign nature of these nodules include architectural arrangement of cells in cohesive clusters and flat sheets; presence of lymphocytes, histiocytes, colloid, cytoplasmic vacuoles, and Hiirthle cells; and a clinical history of treatment with radioactive iodine. From the Department of Pathology and Division of

The atypical thyroid fine‐needle aspiration: Past, present, and future

“…6A and 6B), carbimazole, or other pharmaceutical agents, and can also be noted secondary to reparative changes associated with hemorrhage or cystic degeneration. 3,27,28 Knowledge of the clinical history can help to avoid overdiagnosis, but the atypia may be sufficiently marked that it warrants placing the diagnosis into the AUS/FLUS category.…”

Thyroid Aspiration Cytology: Current Status

“…For example, large nodules may be associated with the higher risk of malignancy, 57 some cytologic features of Hashimoto thyroiditis overlap those seen in papillary carcinoma, 58,59 and I 131 therapy or externalbeam radiation may result in nuclear alterations that simulate those seen in malignancy. 60,62 In occasional patients with Graves disease, aspirates of thyroid nodules may contain benign pleomorphic cells, which may be misinterpreted as malignant. 63 Requisition forms should especially note any family history of papillary or medullary carcinoma and any personal history or neoplasms associated with familial thyroid cancer syndromes.…”

Hurthle Cell Lesions- A Retrospective Review of Final Surgical Pathology

“…Today, a Hurthle cell is defined as an enlarged thyroid follicular cell characterized by a finely granular and deeply acidophilic cytoplasm; the nucleus is also enlarged and shows a predominant nucleolus [5]. Hurthle cells can be found in other non-neoplastic conditions of the thyroid gland including Hashimoto's thyroiditis, multinodular goiter, Graves' disease, and in patients who have been treated with radioactive iodine and systemic chemotherapy [6][7][8][9][10][11][12].…”