AccScience Publishing / JBM / Online First / DOI: 10.14440/jbm.2024.0139
Submit to JBM
Cite this article
9
Download
209
Views
Journal Browser
Volume | Year
Issue
Search
Forthcoming Issue
Current Issue
View All
News and Announcements
View All
REVIEW

Differential diagnosis of Hashimoto’s thyroiditis: The importance of pathological anatomy

Hernando Vargas-Uricoechea1* ,  Ivonne Meza-Cabrera2 ,  Alejandro Castellanos-Pinedo3 ,  Karen Urrego-Noguera1 ,  María V. Pinzón-Fernández4
Show Less
1 Department of Internal Medicine, Faculty of Health Sciences, University of Cauca, Popayán, 190001 Cauca, Colombia
2 Department of Pathology, Faculty of Health Sciences, University of Cauca, Popayán, 190001 Cauca, Colombia
3 Department of Internal Medicine, Faculty of Medicine, University of Sinú, Hospital San Jerónimo, Montería, 230001 Córdoba, Colombia
4 Department of Internal Medicine, University of Cauca, Popayán, 190001 Cauca, Colombia
JBM, e99010064 https://doi.org/10.14440/jbm.2024.0139
Submitted: 16 December 2024 | Revised: 2 April 2025 | Accepted: 12 May 2025 | Published: 7 August 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Download PDF
Cite
XML
Abstract

Background: Hashimoto’s thyroiditis (HT) represents a complex, multifactorial autoimmune disease characterized by a broad spectrum of clinical and imaging presentations. These manifestations tend to be clinically perplexing, necessitating additional tests. In cases where a malignancy is suspected or obstructive symptoms are present, surgical management may be required. Histopathologically, HT is hallmarked by significant lymphocytic infiltration of the thyroid gland, typically with prominent germinal centers, small lymphocytes, centrocytes, centroblasts, plasma cells, and occasionally immunoblasts. The degree of fibrosis varies, giving the gland a lobulated appearance and, in some cases, resulting in a fibrous variant, which, biochemically, is usually accompanied by hypothyroidism. Objective: This review provided a diagnostic and differential approach to HT, highlighting the utility of histopathological examination. Conclusion: Histopathological analysis helps broaden the diagnostic and therapeutic horizon in individuals with HT.

Keywords
Thyroiditis
Hashimoto
Autoimmunity
Histopathology
Funding
This study was funded by the Colombian Association of Endocrinology, Diabetes, and Metabolism (grant number: 20240612A).
Conflict of interest
The authors declare no conflicts of interest.
References
  1. Lichiardopol C, Moţa M. The thyroid and autoimmunity. Rom J Intern Med. 2009;47(3):207-215.

 

  1. Ragusa F, Fallahi P, Elia G, et al. Hashimotos’ thyroiditis: Epidemiology, pathogenesis, clinic and therapy. Best Pract Res Clin Endocrinol Metab. 2019;33(6):101367. doi: 10.1016/j.beem.2019.101367

 

  1. Hu X, Chen Y, Shen Y, Tian R, Sheng Y, Que H. Global prevalence and epidemiological trends of Hashimoto’s thyroiditis in adults: A systematic review and meta-analysis. Front Public Health. 2022;10:1020709. doi: 10.3389/fpubh.2022.1020709

 

  1. Mohamed-Ahmed O, Shang L, Wang L, Chen Z, Kartsonaki C, Bragg F. Incidence and prevalence of autoimmune diseases in China: A systematic review and meta-analysis of epidemiological studies. Glob Epidemiol. 2024;8:100158. doi: 10.1016/j.gloepi.2024.100158

 

  1. Taylor PN, Albrecht D, Scholz A, et al. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol. 2018;14(5):301-316. doi: 10.1038/nrendo.2018.18

 

  1. Xu J, Ding K, Mu L, et al. Hashimoto’s thyroiditis: A “Double- Edged Sword” in thyroid carcinoma. Front Endocrinol (Lausanne). 2022;13:801925. doi: 10.3389/fendo.2022.801925

 

  1. Li G, He L, Huang J, et al. miR-142-3p encapsulated in T lymphocyte-derived tissue small extracellular vesicles induces Treg function defect and thyrocyte destruction in Hashimoto’s thyroiditis. BMC Med. 2023;21(1):206. doi: 10.1186/s12916-023-02944-4

 

  1. Luo J, Zhou L, Sun A, Min Y, Lin Y, Han L. Clinical comparative efficacy and therapeutic strategies for the Hashimoto’s thyroiditis: A systematic review and network meta-analysis. Heliyon. 2024;10(16):e35114. doi: 10.1016/j.heliyon.2024.e35114

 

  1. Alzahrani AS. The risk of expanding risk stratification in thyroid cancer. J Clin Endocrinol Metab. 2023;108(10):e1147-e1148. doi: 10.1210/clinem/dgad410

 

  1. Amino N, Tada H, Hidaka Y, Hashimoto K. Hashimoto’s disease and Dr. Hakaru Hashimoto. Endocr J. 2002;49(4): 393-397. doi: 10.1507/endocrj.49.393

 

  1. Hashimoto H. Zur Kenntniss der lymphomatösen Veränderung der Schilddrüse (Struma lymphomatosa). Arch Klin Chir. 1912;97:219-248.

 

  1. Caturegli P, De Remigis A, Chuang K, Dembele M, Iwama A, Iwama S. Hashimoto’s thyroiditis: Celebrating the centennial through the lens of the Johns Hopkins hospital surgical pathology records. Thyroid. 2013;23(2):142-150. doi: 10.1089/thy.2012.0393

 

  1. Sawin CT. The heritage of Dr. Hakaru Hashimoto (1881-1934). Endocr J. 2002;49(4):399-403. doi: 10.1507/endocrj.49.399

 

  1. Hiromatsu Y, Satoh H, Amino N. Hashimoto’s thyroiditis: History and future outlook. Hormones (Athens). 2013;12(1): 12-18. doi: 10.14310/horm.2002.1407

 

  1. Duntas L, Geroulanos S, Laurberg P. From hippocrates of kos to hashimoto and thyroid autoimmunity: A long road of discovery. Hormones (Athens). 2013;12(1):9-11. doi: 10.14310/horm.2002.1406

 

  1. Rose NR, Witebsky E. Studies on organ specificity. V. Changes in the thyroid glands of rabbits following active immunization with rabbit thyroid extracts. J Immunol. 1956;76(6):417-427.

 

  1. Bahn R, Doniach T, McLachlan S. Deborah doniach: Discovering thyroid autoimmunity: The end of horror autotoxicus. Thyroid. 2020;30(7):942-947. doi: 10.1089/thy.2020.0124

 

  1. Pearce W. Deborah doniach. Lancet. 2004;363(9413):995. doi: 10.1016/S0140-6736(04)15740-7

 

  1. Laios K, Lagiou E, Konofaou V, Piagkou M, Karamanou M. From thyroid cartilage to thyroid gland. Folia Morphol (Warsz). 2019;78:171-173.doi: 10.5603/FM.a2018.0087

 

  1. Khan YS, Farhana A. Histology, Thyroid Gland; 2022. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/ nbk551659 [Last accessed on 2024 Oct 10].

 

  1. Wening BM, Heffess CS, Adair CF. Atlas of Endocrine Pathology. Philadelphia, PA: W.B. Saunders Co; 1997. p. 53-55. Available from: https://search.lib.uiowa.edu/ primo-explore/fulldisplay?vid=01iowa&docid=01iowa_ alma21326893400002771&lang=en_us&context=l [Last accessed on 2024 Sep 10].

 

  1. Mincer DL, Jialal I. Hashimoto thyroiditis; 2023. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/nbk459262 [Last accessed on 2024 Aug 07].

 

  1. Lloyd RV, Douglas BR, WF Y, editors. Endocrine Diseases. Washington, DC: The American Registry of Pathology; 2002. p. 91-149.

 

  1. Vargas-Uricoechea H. Autoimmune thyroid disease and differentiated thyroid carcinoma: A review of the mechanisms that explain an intriguing and exciting relationship. World J Oncol. 2024;15(1):14-27. doi: 10.14740/wjon1667

 

  1. Slatosky J, Shipton B, Wahba H. Thyroiditis: Differential diagnosis and management. Am Fam Physician. 2000;61(4):1047-1052.

 

  1. Stasiak M, Lewiński A. New aspects in the pathogenesis and management of subacute thyroiditis. Rev Endocr Metab Disord. 2021;22(4):1027-1039. doi: 10.1007/s11154-021-09689-5

 

  1. Kjellerup CR, Thomsen MJ, Torp NMU, Karmisholt J, Andersen SL. Characteristics of patients with subacute thyroiditis. Dan Med J. 2023;70(11):A05230318.

 

  1. Cui Z, Wang Z, Liu X, Cai Y, Xu X, Yang T. Establishment of clinical diagnosis model of Graves’ disease and Hashimoto’s thyroiditis. J Transl Med. 2019;17(1):11. doi: 10.1186/s12967-018-1759-2

 

  1. Daramjav N, Takagi J, Iwayama H, et al. Autoimmune thyroiditis shifting from hashimoto’s thyroiditis to graves’ disease. Medicina (Kaunas). 2023;59(4):757. doi: 10.3390/medicina59040757

 

  1. Lee JS, Shin SJ, Yun HJ, et al. Primary thyroid lymphoma: A single-center experience. Front Endocrinol (Lausanne). 2023;14:1064050. doi: 10.3389/fendo.2023.1064050

 

  1. Travaglino A, Pace M, Varricchio S, et al. Hashimoto thyroiditis in primary thyroid non-hodgkin lymphoma. Am J Clin Pathol. 2020;153(2):156-164. doi: 10.1093/ajcp/aqz157

 

  1. Hristozov K, Dimitrova R, Shishkov S, Stefanova N, Gercheva S. Primary intrathyroidal non-hodgkin lymphoma: A case report. Cureus. 2023;15(10):e47096. doi: 10.7759/cureus.47096

 

  1. Bischoff LA, Ganly I, Fugazzola L, et al. Molecular alterations and comprehensive clinical management of oncocytic thyroid carcinoma: A review and multidisciplinary 2023 update. JAMA Otolaryngol Head Neck Surg. 2024;150(3):265-272. doi: 10.1001/jamaoto.2023.4661

 

  1. Asa SL, Mete O. Oncocytic change in thyroid pathology. Front Endocrinol (Lausanne). 2021;12:678119. doi: 10.3389/fendo.2021.678119

 

  1. Trimboli P, Bojunga J, Deandrea M, et al. Reappraising the role of thyroid scintigraphy in the era of TIRADS: A clinically-oriented viewpoint. Endocrine. 2024;85(3):1035-1040. doi: 10.1007/s12020-024-03531-9

 

  1. Zala A, Berhane T, Juhlin CC, Calissendorff J, Falhammar H. Riedel thyroiditis. J Clin Endocrinol Metab. 2020; 105(9):dgaa468. doi: 10.1210/clinem/dgaa468

 

  1. Clifford LM, Joseph F. Difficulties in investigating and treating fibrosing thyroid disorder (overlap of fibrosing variant of Hashimoto’s thyroiditis and Riedel’s thyroiditis). BMJ Case Rep. 2024;17(5):e258917. doi: 10.1136/bcr-2024-258917

 

  1. Gosi SKY, Nguyen M, Garla VV. Riedel thyroiditis; 2023. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/ nbk537303 [Last accessed on 2024 Sep 18].

 

  1. Osborne D, Choudhary R, Vyas A, et al. Hashimoto’s thyroiditis effects on papillary thyroid carcinoma outcomes: A systematic review. Cureus. 2022;14(8):e28054. doi: 10.7759/cureus.28054

 

  1. Prajapati S, Hernandez-Prera JC. Putting all the pieces together: Clinical, macroscopic and microscopic characteristics of subacute thyroiditis. Head Neck Pathol. 2019;13(2):231-234. doi: 10.1007/s12105-019-01012-5

 

  1. Harach HR, Williams ED. The pathology of granulomatous diseases of the thyroid gland. Sarcoidosis. 1990;7(1):19-27.

 

  1. LiVolsi VA, Baloch ZW. The pathology of hyperthyroidism. Front Endocrinol (Lausanne). 2018;9:737. doi: 10.3389/fendo.2018.00737

 

  1. Ippolito S, Piantanida E, Tanda ML, Caturegli P. Graves’ disease insights from a review of the johns hopkins surgical pathology archive. J Endocrinol Invest. 2020;43(10): 1519-1522. doi: 10.1007/s40618-020-01279-9

 

  1. Sun H, Ma J, Chen Y, Liu M. Primary thyroid lymphoma-- report of four cases and literature review. Int J Clin Exp Pathol. 2023;16(5):99-107.

 

  1. Su MW, Beck TN, Knepprath J, Romero-Velez G, Heiden KB, McHenry CR. Primary thyroid lymphoma: A multi-center retrospective review. Am J Surg. 2024;237:115927. doi: 10.1016/j.amjsurg.2023.115927

 

  1. Vita O, Dema A, Barna R, et al. Primary thyroid lymphoma: A retrospective-observational study in a single institutional center. Medicina (Kaunas). 2024;60(3):476. doi: 10.3390/medicina60030476

 

  1. Liu H, Lin F. Application of immunohistochemistry in thyroid pathology. Arch Pathol Lab Med. 2015;139(1):67-82. doi: 10.5858/arpa.2014-0131-RA

 

  1. Crescenzi A, Baloch Z. Immunohistochemistry in the pathologic diagnosis and management of thyroid neoplasms. Front Endocrinol (Lausanne). 2023;14:1198099. doi: 10.3389/fendo.2023.1198099

 

  1. Suster D, Ronen N, Giorgadze T. Oncocytic nodular hyperplasia of the thyroid. Ann Diagn Pathol. 2022;61:152049. doi: 10.1016/j.anndiagpath.2022.152049

 

  1. Suster D, Mackinnon AC, Suster S. Thyroid oncocytic (Hürthle Cell) nodules with longitudinal nuclear grooves: Clinicopathologic, immunohistochemical, and molecular genetic study of 15 cases. Arch Pathol Lab Med. 2023;147(6):684-691. doi: 10.5858/arpa.2022-0327-OA

 

  1. Czarnywojtek A, Pietrończyk K, Thompson LDR, et al. IgG4- related sclerosing thyroiditis (Riedel-Struma): A review of clinicopathological features and management. Virchows Arch. 2023;483(2):133-144. doi: 10.1007/s00428-023-03594-6

 

  1. Caron P. Riedel’s thyroiditis: Report of 7 patients and review of literature. Endocrine. 2024;85(2):811-816. doi: 10.1007/s12020-024-03507-9

 

  1. Hakeem AH, Chandramathyamma SK, Hakeem IH, Wani FJ, Gomez R. Riedel’s thyroiditis mimicking as anaplastic thyroid carcinoma: Unusual presentation. Indian J Surg Oncol. 2016;7(3):359-362. doi: 10.1007/s13193-016-0546-2
Share
Back to top
Journal of Biological Methods, Electronic ISSN: 2326-9901 Print ISSN: TBA, Published by POL Scientific
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here
Accept