What is the best summary of thyroid gland pathology?

From the Guidelines

The best resume of thyroid pathology should prioritize comprehensive experience with the full spectrum of thyroid disorders, highlighting expertise in diagnosing and managing conditions like Hashimoto's thyroiditis, Graves' disease, multinodular goiter, thyroid nodules, and thyroid cancers (papillary, follicular, medullary, and anaplastic), as recommended by the most recent guidelines 1.

Key Areas of Expertise

• Fine needle aspiration cytology interpretation
• Histopathological examination of thyroid specimens
• Molecular testing methods like BRAF V600E mutation analysis
• Thyroid function tests interpretation, including TSH, free T3, free T4, thyroid antibodies, and calcitonin levels
• Correlating clinical, laboratory, radiological, and pathological findings to establish accurate diagnoses

Emphasis on Clinical Implications

• Knowledge of the WHO classification of thyroid tumors and TNM staging systems
• Experience with challenging cases like poorly differentiated thyroid carcinomas and thyroid lymphomas
• Quantify experience with approximate numbers of cases examined
• Highlight any specialized training or research in thyroid pathology

Recent Guidelines and Recommendations

• The NCCN Guidelines Insights summarize the panel discussion behind recent updates to the guidelines, including the expanding role of molecular testing for DTC, implications of the new pathologic diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), and the addition of a new targeted therapy option for BRAF V600E–mutated ATC 1
• The ACR Appropriateness Criteria highlight the importance of imaging in diagnosing and characterizing thyroid findings, as well as the role of thyroid ultrasound (US) supplemented by fine needle aspiration cytology (FNAC) in detecting and characterizing nodular thyroid disease 1
• The ESMO clinical practice guidelines for diagnosis, treatment, and follow-up of thyroid cancer emphasize the importance of total or near-total thyroidectomy as the initial treatment of DTC, as well as the use of radioiodine ablation and TSH suppressive therapy in high-risk patients 1

From the Research

Thyroid Pathology Overview

• Thyroid pathology has seen significant advances in the past half century, particularly in the diagnosis and treatment of neoplastic lesions 2
• The incorporation of fine needle aspiration biopsy and molecular analysis has improved the understanding of thyroid neoplastic development and diagnostic parameters 2

Diagnosis and Treatment of Thyroid Diseases

• Functional thyropathies, such as hypothyroidism and hyperthyroidism, present significant health risks and require proper diagnosis and treatment 3
• Levothyroxine is the drug of choice for substitution therapy in hypothyroidism, while methimazole is commonly used to treat hyperthyroidism 3, 4
• Hyperthyroidism can be treated with antithyroid medications, radioactive iodine ablation, or surgical thyroidectomy, depending on the underlying diagnosis and patient preference 4

Imaging and Biopsy Techniques

• Ultrasonography is the most commonly used imaging modality for characterizing thyroid nodules, with features such as microcalcifications and solid composition increasing the likelihood of malignancy 5
• Fine-needle aspiration biopsy (FNAB) and core biopsy are used to obtain specimens for cytologic analysis, with careful technique and specimen processing crucial for making an accurate diagnosis 5

Best Practice Guidelines

• Thyroid pathology is a specialist area that requires unique diagnostic approaches and techniques 6
• Best practice guidelines have been established to provide practical guidance for general pathologists encountering thyroid pathology in various forms, including cytology, frozen sections, and resection specimens 6