Ultrastructural pathology in Hashimoto's thyroiditis

Histological Alterations in Hashimoto's Disease: A Case-Series Ultrastructural Study

BACKGROUND

Hashimoto's thyroiditis (HT) is an autoimmune disease exhibiting stromal fibrosis and follicular cell destruction due to lymphoplasmacytic infiltration. Besides deprecated analyses, histopathological approaches have not employed the use of electron microscopy adequately toward delineating subcellular-level interactions.

METHODS

Biopsies for ultrastructural investigations were obtained from the thyroids of five patients with HT after a thyroidectomy. Transmission electron microscopy (TEM) was utilized to study representative tissue specimens.

RESULTS

Examination indicated interstitial extravasated blood cells and a plethora of plasma cells, based on their subcellular identity landmarks. These antibody-secreting cells were profoundly spotted near follicular cells, fibroblasts, and cell debris entrenched in collagenous areas. Pathological changes persistently affected subcellular components of the thyrocytes, including the nucleus, endoplasmic reticulum (ER), Golgi apparatus, mitochondria, lysosomes, and other intracellular vesicles. Interestingly, significant endothelial destruction was observed, specifically in the larger blood vessels, while the smaller vessels appeared comparatively unaffected.

CONCLUSIONS

Our TEM findings highlight the immune-related alterations occurring within the thyroid stroma. The impaired vasculature component and remodeling have not been described ultrastructurally before; thus, further exploration is needed with regards to angiogenesis in HT in order to achieve successful prognostic, diagnostic, and treatment-monitoring strategies.

Hashimoto's thyroiditis

Goiters were often associated with iodine deficiency in European mountain areas, with some goiters being quite disfiguring. However, some goiters seem not to be related to iodine deficiency. One of the types of goiter that are unrelated to iodine deficiency is the disease described by Hakaru Hashimoto in 1912. Hashimoto described it as a special characteristic of a new type of lymphomatous thyroid tumor in Japan, and this entity was recognized as an autoimmune disease of the thyroid many years later. Hashimoto published his article in a German journal because that was the scientific language of the time, and he thought that writing in German would make the work more widely available around the world. Patients with Hashimoto's thyroiditis are usually asymptomatic, and some patients develop goiters with or without hypothyroidism. The goiters and hypothyroidism usually respond to treatment with thyroid hormone. The dose of thyroid hormone must be carefully titrated because there may be autonomous thyroid function resulting from thyroid-stimulating antibodies despite the hypothyroid state.

Ultrastructural localization of thyroid peroxidase, hydrogen peroxide-generating sites, and monoamine oxidase in benign and malignant thyroid diseases

Despite thyroid tissue heterogeneity, biochemical and morphological features have been associated with certain thyroid diseases. We analyzed the ultracytochemical localization of thyroperoxidase (TPO), TPO-associated hydrogen peroxide-generating sites (H(2)O(2) sites), and monoamine oxidase (MAO) in terms of morphology and biochemical TPO activity in abnormal thyroids. We examined 11 cases of nontoxic multinodular goiter, 5 cases of Hashimoto's thyroiditis, 1 case of oncocytic (Hürthle or oxyphilic cell) adenoma, 5 cases of Graves' disease, 4 cases of papillary carcinoma, and 4 cases of perinodular normal tissue. In the perinodular tissue, TPO was detected mainly in the nuclear envelope, rough endoplasmic reticulum (RER), and subapical vesicles, but not in the apical surface. In multinodular goiter, heterogeneous TPO reactivity ranging from almost null to strongly positive was detected in similar locations as in the perinodular tissue, and was absent in the microvilli. Follicular cells from Hashimoto's thyroiditis displayed TPO in the nuclear envelope and the scarce RER. Remarkably, oncocytic cells from both Hashimoto's thyroiditis and oncocytic adenoma, typically packed with mitochondria, displayed evident TPO reaction exclusively in mitochondrial cristae. In Graves' disease, the nuclear envelope, enlarged RER, and apical vesicles were strongly TPO positive, and microvilli also exhibited TPO activity. Papillary carcinoma cells were negative for TPO. The localization and characteristics of TPO activity in the H(2)O(2) sites were similar to that of TPO in all tissues. MAO was positive in mitochondria of perinodular tissues, multinodular goiter, and oncocytes and negative in Hashimoto's thyroiditis and Graves' disease. Interestingly, MAO was intensely positive in the nuclear envelope of papillary carcinoma but unreactive in mitochondria. Biochemical TPO activity was increased in multinodular goiter and Graves' disease. In conclusion, several changes in ultracytochemical characteristics of TPO, H(2)O(2) sites, and MAO were associated with thyroid disease. Nonmalignant oncocytic cells exhibited an unusual mitochondrial location of TPO and H(2)O(2) sites. The distribution of MAO in nuclear envelope of papillary carcinoma cells could be a further feature of malignancy.

The epitheliomeral concept of the thyroid gland's structural organization

BACKGROUND

The permanent increase in the number of cases of different forms of thyroid pathology requires a deeper study of the thyroid structure and its morphogenetic processes.

METHODS

The thyroid glands of Wistar rats were used in a composite study that involved standard light microscopy, semithin sections, silver staining, immunohistochemistry, morphometry, three-dimensional analysis, and computer-assisted three-dimensional reconstruction.

RESULTS

The absolute majority of follicles have from one to seven interfollicular contacts (C) with other neighbouring follicles. The surface of C makes up 32% of the follicular basal surface. In the central zone of 1-micron-thick sections, the relative quantity of C per follicle (0.44 +/- 0.05) is 36% more than in the peripheral zone (0.28 +/- 0.07; P < 0.05). The analysis of serial sections shows that 134 follicles have 133 C. Only three follicles are separate; four form pair groups, and others form groups that include up to 92 follicles. Follicles form linear chains with numerous branches. A three-dimensional reconstruction demonstrates a spatial configuration of the parenchyma's elements. In C, the basement membrane is absent. Consequently, a group of interconnected follicles form a parenchymal compartment with a common basement membrane. We named these parenchymal compartments "epitheliomers." Both the formation of new follicles and follicular fusion take place within the boundaries of the epitheliomer without violating the integrity of the compartment. The fusion of follicles is brought on by the destruction of the epithelium of C.

CONCLUSIONS

The authors put forward a new "epitheliomeral" concept with regard to the structural organization of the thyroid gland.

The interstitial space of the thyroid gland of marmosets (Callithrix jacchus)

The interstitial space of the thyroid gland of adult marmosets contains, like the stroma of other organs, cells and intercellular substance (matrix), blood vessels (predominantly capillaries), lymph vessels and unmyelinated nerves. It is demarcated from the follicular epithelium, the capillaries and Schwann cells by a basal lamina (BL). The perifollicular BL shows thickenings of up to 3 microns over long distances or a multilayered arrangement. These thickened segments exhibit numerous epithelial processes and ridges; in other words, the contour of the basal cell membrane is very irregular in these areas. Indentations of capillaries into the epithelium are rarely observed. The endothelium is only slightly porous. Lymph capillaries occur in large numbers. They originate freely in the interstitial space, show gaps or unspecific contacts between the thin endothelial cells; a basal lamina is missing. Bundles of 10-nm thick filaments (anchor filaments) extend to the endothelial cells of the lymph capillaries. Thin and very long (up to 8 microns) plate-like processes surround the capillaries or run parallel to the outer contour of the follicles. They originate at the poles of oval, fibroblast-like cells. Since these cells are FXIII- and C3bi-positive, they can be considered as dendritic cells. They obviously play a role in the frequently-observed autoimmune diseases of this species. In addition, monocytes and all transitional forms including macrophages, fibrocytes and lymphocytes as well as numerous mast cells occur. In the region of the BL, integrins of the beta 1-group (alpha 6) can be demonstrated immunohistologically in addition to the usual components (collagen type IV, laminin and heparan sulfate-proteoglycan). Of the fibrillar collagens type I does not occur, type III occurs only in small amounts, whereas types V and VI are observed in large amounts. The presented findings may serve as basis for more extensive experiments on these primates.

Paraganglioma-like (hyalinizing trabecular) adenoma of the thyroid revisited

The aim of the present study was to explore the association between paraganglioma-like adenomas of the thyroid (PLAT) and chronic lymphocytic thyroiditis (CLT) or Hashimoto's thyroiditis, and to discuss its possible relationship to papillary thyroid carcinoma. Six cases were analyzed by standard histopathological and immunohistochemical techniques. All 6 cases (all females) had clinical and/or histological evidence of CLT. Only one patient had 2 PLATs. The PLATs were devoid of inflammation and sharply demarcated from the surrounding CLT. There is cyto-morphological overlap with papillary thyroid carcinoma (nuclear grooves and pseudo-inclusions). We conclude that PLAT is associated with CLT more frequently than any other thyroid lesion, and feel that this is more than merely a chance association. PLAT shares several cytological features with papillary carcinoma and cases have been seen where they have occurred in the same thyroid. PLAT could therefore represent an unusual variant of papillary carcinoma.

The pathology of autoimmune thyroid disease: a review

Lymphocytic infiltration of the thyroid gland is the pathologic hallmark of autoimmune thyroid disease. Lymphoid cells are seen in the stroma of glands affected by Graves' disease. However, large lymphoid infiltrates are characteristic of that spectrum of diseases conveniently termed chronic lymphocytic thyroiditis. In this review, the pathology of the various subtypes of chronic thyroiditis is enumerated, including recently defined lesions, i.e., painless thyroiditis, thyroiditis associated with interleukin chemotherapy, and peritumor thyroiditis are reviewed. The unifying morphologic characteristics seen in these conditions are discussed.

Autoimmune thyroid disease: immunological, pathological, and clinical aspects

Autoimmune thyroiditis, most notably Hashimoto's thyroiditis, appears to be increasing in prevalence and is now more easily detected by sensitive laboratory tests and more invasive procedures such as fine needle aspiration. During the last decade, marked progress has been made in the understanding of these diseases. There is a greater awareness of the interaction between the humoral and cell-mediated arms of the immune system in autoimmune thyroiditis. Recent studies implicate a subpopulation of suppressor T lymphocytes which have an antigen-specific defect, resulting in their suboptimal interaction with the helper T lymphocytes and subsequent autoimmune manifestations. There is some evidence that thyroid epithelial cells which inappropriately express HLA-DR may enhance presentation of thyroid antigens to the immune system, possibly significant in the initiation or enhancement of the autoimmune response. The presence of various antithyroid autoantibodies allows the use of laboratory assays to confirm the clinical diagnosis and predict the results of treatment. There appears to be predisposing genetic factors in the development of autoimmune thyroiditis, with some geographical and racial differences. Environmental factors, most notably dietary intake of iodine, have also been implicated in the pathogenesis of Hashimoto's thyroiditis. Several animal models have been developed addressing such issues. Ongoing studies in the areas of postpartum thyroiditis and childhood thyroiditis are helpful in clarifying their relationship with Hashimoto's thyroiditis. Graves' disease and postpartum thyroiditis are being investigated as possible causes of postpartum depression. The association of Hashimoto's thyroiditis and carcinoma of the thyroid gland is still controversial, but its relationship with malignant lymphoma is now well accepted. Thus, although the pathogenesis of autoimmune thyroiditis remains elusive, there has been significant refinement of the clinical diagnosis, and immunological abnormalities of specific intrathyroidal lymphocytes have been identified. Hopefully, these new areas of knowledge will assist in the treatment of these diseases and in the prevention of the development of malignant lymphomas of the thyroid gland.

Solid cell nests (SCN) in Hashimoto's thyroiditis

In Hashimoto's thyroiditis squamous metaplasia has been described by several authors. Such foci resemble the so-called solid cell nests (SCN) of the thyroid, epidermoid structures thought to be remnants of the fourth endodermal pouch. These cell nests can be identified by their particular histological appearances and by their positive reaction with polyclonal anti-CEA. In order to study this phenomenon more closely we examined the H & E-stained histological sections of 79 cases of Hashimoto's thyroiditis systematically. In 39 cases cell nests of three different types could be demonstrated: Small groups of elongated cells organized into solid epidermoid clusters, larger epithelial cells forming solid nests or similar epithelial but cystic structures. 29 of these 39 cases were further investigated immunohistochemically for the presence of thyroglobulin, CEA (polyclonal antiserum) and calcitonin. The first type of cell nest did not show any CEA-positivity, whereas the second and third type contained CEA-positive cells in 73% of the cases. In no cases were thyroglobulin- or calcitonin-positive cells identified in these epidermoid foci. Slide series of 25 of the 39 cases have further been investigated immunohistochemically for the presence of CEA (monoclonal antiserum), chromogranin, keratin and the epitope for Lu-5. In these additional series foci of epidermoid cells could be demonstrated in up to 15 of the 25 cases. They showed a positive reaction for the monoclonal CEA antiserum in only 3 of 15 cases, for anti-keratin in 5 of 14 cases and for Lu-5 in 13 of 15 cases. Immunoreactions for chromogranin were negative in all cases. Our findings suggest that epidermoid cell nests in Hashimoto's thyroiditis more closely resemble SCN than foci of follicular cell squamous metaplasia.

Evolution and host-dependent lesions in autoimmune thyroiditis: experimental study in inbred mice

The evolution of thyroid pathology in experimental autoimmune thyroiditis was studied in several inbred strains of mice. The disease was induced by immunization with mouse thyroglobulin emulsified in Freund's complete adjuvant. In addition to the common lymphoid/mononuclear cell infiltration seen in other animal species with experimental autoimmune thyroiditis, several distinct thyroid lesions occurred only in certain strains of mice, suggesting a strain-dependency of these lesions. These lesions appeared often at the peak of the common lesion of autoimmune thyroiditis. These findings suggest that the thyroid pathology in murine autoimmune thyroiditis varies during its course and that some lesions occurring in this disease are strain-dependent. A genetic influence on the morphology of thyroid in chronic thyroiditis of man is postulated.