chronic lymphocytic thyroiditis (Hashimoto) ICD-10: E06.3
weitere Informationen auf HiPaKu
Frau, 50 J., langsam wachsende, symmetrische Struma, schmerzfrei,
schleichend beginnende Hypothyreose. Strumektomie wegen Stridor
- Diffuse lymphozytäre Infiltrate im Schilddrüsengewebe
mit Lymphfollikelbildung
- Schilddrüsenfollikel teilweise zerstört,
Bildung von Strängen, bestehend aus Follikelepithelzellen mit
teilweiser onkozytärer Metaplasie
- Viele B-Lymphozyten und Plasmazellen mit braunem Reaktionsprodukt
Immunologische Ueberempfindlichkeitsreaktion Typ II: Zytotoxische
Zerstörung der Follikelepithelzellen; da die ganze Schilddrüse
befallen ist, endet diese Erkrankung oft in einer Hypothyreose
Vergleich: Präparat A IV 14, A IV 19
50-year-old female experienced a slowly progressive painless symmetrical enlargement of the thyroid gland.
In addition, she started to develop hypothyroidism. Presence of a stridor required thyroidectomy.
- Parenchyma diffusely infiltrated by a mononuclear inflammatory infiltrate containing small lymphocytes and plasma cells. Secondary lymph follicles (Lymphfollikelbildung)
with well-developed germinal centers are present throughout the gland.
- Many atrophic thyroid follicles exhibit epithelial cells with abundant eosinophilic granules (Hürthle or oxyphil cells). Follicles are partly
destroyed (zerstört), epithelial strands are formed with partial oncocytic metaplasia (Metaplasie) .
- Immune histochemistry staining for IgM reveals the abundance of plasma cells.
Pathogenesis: cellular and humoral immune mechanisms contribute to this autoimmune disease that ultimately destroys the follicular epithelium.
A well-known mechanism is the production of auto-antibodies against thyroglobulin and other follicular cell antigens. Presentation of auto-antibodies
by follicle cells is followed by antibody-dependent cell-mediated cytotoxicity (ADCC) involving NK-cells (antibody-mediated (Type II) hypersensitivity).
Hypothyroidism usually ensues, because the whole gland is uniformly affected.
A IV 14, A
IV 19