Bilateral Thyroid Nodules

Abstract

Awoman in her 60s presented with bilateral thyroid nodules discovered by her endocrinologist 2 weeks prior to being referred to anotolaryngologist. Hermedical historywas remarkable for hypertension, hypercholesterolemia, depression, and gastroesophageal reflux disease. She had a history of smoking but quit in 1998. She had throat discomfort and coughing episodes but denied any fevers, chills, dysphagia, odynophagia, constitutional symptoms, and previous radiation exposure. Findings fromthephysical examinationwerenormal except for greater fullness on palpation on the right side than the left. Ultrasonography showed a 3.2 × 2.1-cmnodule in the upper tomid pole of the right lobe and a 2.3 × 1.5-cm nodule in the upper pole of the left lobe. A sample from fine-needle aspiration (FNA) of both nodules showed cells suspicious for papillary thyroid cancer. A total thyroidectomy demonstrated 3 tan nodules in the right lobemeasuring 0.5 cm, 0.5 cm, and 0.4 cm in their greatest dimensions in the upper, middle, and lower poles, respectively. Nodules were not identified in the isthmus or left lobe. The entire thyroid capsular surface was smooth and unremarkable. On the cut section, the thyroid parenchyma in both lobes was nearly effaced by white fibrous tissue. Hematoxylin-eosin–stained sections exhibited thyroid follicles destroyed by inflammatory cells consisting of lymphocytes, histiocytes, and giant cells (Figure, A), and at medium power they revealed destroyed follicles containing an admixture of histiocytes, lymphocytes, plasma cells, and neutrophils (Figure, B) and follicular epithelium replaced by histiocytes and giant cells (Figure, C). What is your diagnosis? A B C