Thyroid adenoma


A thyroid adenoma is a benign tumor of the thyroid gland, that may be inactive or active as a toxic adenoma.

Signs and symptoms

A thyroid adenoma may be clinically silent, or it may be a functional tumor, producing excessive thyroid hormone. In this case, it may result in symptomatic hyperthyroidism, and may be referred to as a toxic thyroid adenoma.

Diagnosis

Morphology

Thyroid follicular adenoma ranges in diameter from 3 cm on an average, but sometimes is larger or smaller. The typical thyroid adenoma is solitary, spherical and encapsulated lesion that is well demarcated from the surrounding parenchyma. The color ranges from gray-white to red-brown, depending upon
  1. the cellularity of the adenoma
  2. the colloid content.
Areas of hemorrhage, fibrosis, calcification, and cystic change, similar to what is found in multinodular goiters, are common in thyroid adenoma, particularly in larger lesions.

Types

Almost all thyroid adenomas are follicular adenomas. Follicular adenomas can be described as "cold", "warm" or "hot" depending on their level of function. Histopathologically, follicular adenomas can be classified according to their cellular architecture and relative amounts of cellularity and colloid into the following types:
Papillary adenomas are very rare.

Differential diagnosis

A thyroid adenoma is distinguished from a multinodular goiter of the thyroid in that an adenoma is typically solitary, and is a neoplasm resulting from a genetic mutation in a single precursor cell. In contrast, a multinodular goiter is usually thought to result from a hyperplastic response of the entire thyroid gland to a stimulus, such as iodine deficiency.
Careful pathological examination may be necessary to distinguish a thyroid adenoma from a minimally invasive follicular thyroid carcinoma.

Management

Most patients with thyroid adenoma can be managed by watchful waiting with regular monitoring. However, some patients still choose surgery after being fully informed of the risks. Regular monitoring mainly consists of watching for changes in nodule size and symptoms, and repeat ultrasonography or needle aspiration biopsy if the nodule grows.