If concern arises about the possibility of cancer, the doctor may simply recommend monitoring the nodule over time to see if it grows. Subacute thyroiditis (de Quervains thyroiditis). There are multiple small hypoechoic/mixed cystic and solid nodules in the thyroid gland, Thyroid metastases of renal cell carcinoma: clinical course in 45 patients undergoing surgery. UCSF offers comprehensive consultations and treatments for thyroid conditions, including goiter (enlarged thyroid gland) and thyroid nodules. Herpes sores blister, then burst, scab and heal. Front. Behind the thyroid parenchyma, a type B gland is a superior gland that is exophytic to the thyroid parenchyma and has fallen posteriorly into the tracheoesophageal groove. covering md sent message saying no f/u needed as nodule so small but didn't address #1 finding. Figure1 Ultrasound image and blood flow diagram of the patients lesion. Colorectal cancer metastases to the thyroid gland-a systematic review: colorectal cancer thyroid metastases[J]. Your healthcare provider will perform a physical exam, including assessing your thyroid, and ask you questions about your symptoms and medical history. Rapid heart rate (tachycardia) that can exceed 140 beats per minute. JAMA Netw Open (2021) 4(9):e2124750. This causes hyperthyroidism. Overall throid echogenicity and echo texture are within normal limits. If you have Hashimotos thyroiditis, your provider will prescribe thyroid hormone replacement medication, such as levothyroxine. It is worth noting that most TM patients have multiple systemic metastases at the same time (1820), and a study by Stergianos S (21) noted out that 81% of patients will have metastases in parts of the body other than the thyroid. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Surgery of the Thyroid and Parathyroid Glands (Third Edition), Diagnostic Pathology: Intraoperative Consultation (Second Edition), Imaging Anatomy: Ultrasound (Second Edition), Diagnostic Pathology: Head and Neck (Second Edition), Diagnostic Pathology: Endocrine (Second Edition), Advances in the Diagnosis and Surgical Management of Medullary Thyroid Carcinomas, Advances in Treatment and Management in Surgical Endocrinology, Thyroid Hormone Homeostasis in Weight Loss and Implications for Bariatric Surgery, Metabolism and Pathophysiology of Bariatric Surgery. Unable to process the form. Oncol. Fine-needle aspiration cytology (FNAC) is the first choice for patients with suspected metastatic thyroid cancer. When examined with ultrasound imaging, as many as one-third of women and one-fifth of men have small thyroid nodules. Thyroiditis: Types, Causes, Symptoms, Diagnosis & Treatment Your thyroid is a small, butterfly-shaped gland located at the front of your neck under your skin. STIs are the most common cause of genital sores. Y-PT: Resources, Data Curation, Writing - Review & Editing, Supervision. Tsh 0.045. t4 free 1.56. us thyroid shows 1) diffuse heterogeneous thyroid & 2) 6mm solid hypoechoic nodule. B-Cell Non-Hodgkins Lymphoma: viewing an aggressive For patients considering surgery, UCSF offers less invasive approaches that leave either no scar or a small scar hidden under the chin. Theyre available to help you. A list of national and international resources and hotlines to help connect you to needed health and medical services. Almost all cases of enlarged thyroid result from one of the following problems: When the thyroid can't produce enough thyroid hormone, it compensates by getting bigger. It usually goes away on its own without treatment. what does this mean? If the patient has multiple systemic metastases, treatment should be considered according to the primary lesion and the site of metastasis. doi:10.1016/j.ejso.2021.02.018, 22. In the case of Hashimoto's thyroiditis, the resulting hypothyroidism is generally permanent, but its treatable with life-long thyroid hormone replacement therapy. SPot images are available for review. The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. Top answers from doctors based on your search: Created for people with ongoing healthcare needs but benefits everyone. If they suspect you may have thyroiditis after, theyll likely order any combination of the following tests to help diagnose it: The treatment for thyroiditis depends on the type and the symptoms. WebThe US patterns were classified into 4 grades to compare the thyroid echogenicity and anterior strap muscle echogenicity, which was used as a reference: Grade 1 (G1): diffusely enlarged gland with a normoechoic US pattern (similar to normal tissue, and to the submandibular gland, hyperechoic to the anterior strap muscle) ( Fig. WebWhat does diffusely enlarged heterogeneous thyroid gland mean? Received: 22 August 2022; Accepted: 12 April 2023;Published: 28 April 2023. Increased sweating and sensitivity to heat. Youll likely have to take this medication for the rest of your life since the hypothyroidism from Hashimotos thyroiditis is usually permanent. I had a sono on 9/13/2010 and again on 1/24/2011 due to spasms and a large golf size knot coming up in front of my neck for abut 30 seconds each time this happens. (C) Cancer cells positive for CgA (CgA; 400X). That U/S is not specific, but Hashimoto's glands can look like that. Hyperthyroidism can be treated with medication that stops the production of thyroid hormone, radioactive iodine, or removal Cancers (Basel) (2022) 14(12):3017. doi:10.3390/cancers14123017, 3. Should get blood tests to make sure not hypo or hyperthyroid. Diffuse Multinodular goiter (also referred to as nontoxic goiter): This refers to the thyroid gland growing too large. Check TPO and thyroglobulin autoantibodies. The right lobe measures 3.1 cm in maximal dimension and is diffusely heterogeneous. This case suggests that when evaluating thyroid tumors, clinicians should not only carefully identify the clinical features of the tumor but also pay special attention to the patients history of tumors, especially neuroendocrine neoplasms. Thyroid is diffusely heterogeneous in echotexture. Herein, we report a case of rectal NEN metastasis to the thyroid and discuss the diagnosis and treatment of this patient. What Do Herpes Sores Look Like at Different Stages. Stergianos S, Juhlin CC, Zedenius J, Calissendorff J, Falhammar H. Metastasis to the thyroid gland: characterization and survival of an institutional series spanning 28 years[J]. T-HZ: Resources, Data Curation, Supervision. Background: Heterogeneous echogenicity of the thyroid gland has been associated with diffuse thyroid disease and benign and malignant nodules can coexist with diffuse thyroid disease. 13:1024908. doi: 10.3389/fonc.2023.1024908. Atrophic Thyroiditis - Cancer Therapy Advisor Its treatable. WebThe relationship between heterogeneous echogenicity of thyroid gland and thyroid tests are well known. You are commenting on an old post, if you want to post as a new question you might get a better response but I will answer here for you. Is HETEROGENEOUS Thyroid normal? | Hypothyroidism | Forums This study aims to improve clinicians ability to diagnose and treat TM and improve patient survival rate and quality of life. Subclinical hypothyroidism: Elevation of TSH with TH levels within normal range. This usually occurs when the brain produces too much thyroid-stimulating hormone. is it serious? This is what the radiology reports says. Heterogeneity means the the texture of the thyroid gland isnt uniform and smooth as seen with a healthy thyroid gland. This texture is spread over the thyroid gland (diffuse). A diffusely heterogeneous thyroid is commonly seen with an autoimmune disease called Hashimotos thyroiditis. Thyroid nodules are extremely common. Advertising on our site helps support our mission. Int J Mol Sci (2022) 23(6):3242. doi:10.3390/ijms23063242, 10. BL: Writing - Review & Editing. The prognosis of TM remains controversial. Cleveland Clinic is a non-profit academic medical center. 1,4 2 3 4 1 Case Report 1 2 3 4 - res.mdpi.com GP: Resources, Data Curation, Writing - Review & Editing. A heterogeneous (or inhomogeneous) thyroid echotexture is usually from thyroiditis (Either Hashimoto's or Silent/Viral). The median survival time reported in previous literature is 8.8-34.0 months (15, 21, 22), and the five-year overall survival rate is 11%-58% (1, 23, 24). Straccia P, Mosseri C, Brunelli C, Rossi ED, Lombardi CP, Fadda G, et al. Full thyroid function recovery from postpartum and silent (painless) thyroiditis also takes about 12 to 18 months. 6. Fibrosis (thickening and scarring) of your thyroid. In January 2019, liver metastases were detected in another examination, followed by multiple metastases in bone and the pelvis. Metastasis of colon cancer to medullary thyroid carcinoma: a case report[J]. This affects about 5 percent of women in the year after pregnancy. Thyroid Nodules: When to Worry | Johns Hopkins Medicine 1. 2. I go to new endo on 15th pray she gives me some answersweight gain 35 plus poundsI hate this. FNAC is simple and easy to perform, and it is the best method for preoperative diagnosis (9). I feel like lead!!!! The patient and their family chose to have regular follow-up examinations without further treatment for the thyroid nodules. Chemotherapy with etoposide 120 mg + cisplatin 60 mg (EP regimen) was given for two cycles one month after surgery. The pain caused by acute infectious thyroiditis and subacute thyroiditis usually can be managed with nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. Your thyroid gland normally produces thyroglobulin (tg), so t Rather than being homogeneous, your thyroid composition is irregular with one cyst. WebDestruction and replacement of thyroid parenchyma by dense collagen (keloid-like bands of fibrosis) . Methods:The aim of this study is to evaluate the correlation of normal US with the thyroid tests. Heterogeneous echogenicity of the underlying thyroid - PubMed The Best IOL for 2022 RXSight Light Adjusted Lens, Will refractive surgery such as LASIK keep me out of glasses all my life. Thyroid By continuing you agree to the use of cookies. doi:10.1245/s10434-016-5683-4, 26. Thyroid C-Cells: Neuroendocrine cells dispersed in the thyroid parenchyma. doi:10.1136/bcr-2018-225549, 4. Here are the result and was just wondering if anyone could hel 5.5 x 1.5 x 1.3 cm. Thyroid diffusely heterogeneous | HealthTap Online Doctor I had an ultrasound done on my thyroid today due to a lump/nodule I found. WebEnter the email address you signed up with and we'll email you a reset link. {"url":"/signup-modal-props.json?lang=us"}, Weerakkody Y, Worsley C, Bell D, et al. Among them, the TSH receptor (TSHR) gene and thyroid peroxidase (TPO) genes account for the majority of mutation-positive cases of dysgenesis and dyshormonogenesis, respectively [5]. Underlying heterogeneous echogenicity might make it difficult to differentiate between benign and malignant nodules on US. Parathyroid glands can also be involved. MedHelp thyroid Thyroid Metastasis to the thyroid gland: a critical Review[J]. Clear cell renal carcinoma metastasis mimicking primary thyroid tumor[J]. BMC Cancer (2020) 20(1):1104. doi:10.1186/s12885-020-07581-y, 11. WebHomogenous echotexture just refers to the texture of the thyroid. Thyroid Ultrasound: Diffuse and Nodular Disease Thyroid Nodules: When to Worry Fine-needle aspiration (FNA) revealed the presence of suspicious tumor cells in the left thyroid nodule and infiltration or metastasis of malignant tumor cells in the left cervical lymph nodes. (A) Rectal neuroendocrine tumors are indicated by white arrows, and normal thyroid epithelial cells are indicated by black arrows (HE; 100X). doi:10.12998/wjcc.v8.i19.4588. "Diffusely and markedly heterogeneous" means it's lumpy all over. It has several different causes depending on the type. Your provider may switch you to a different but similar medication to treat the thyroiditis or they may prescribe levothyroxine (thyroid hormone medication) while you continue to take the medication causing thyroiditis. Yeo SJ, Kim KJ, Kim BY, Jung CH, Lee SW, Kwak JJ, et al. These include: Cancer Cytopathol (2015) 123(1):1929. The postoperative pathology showed that the endocrine tumor of the rectum was a well-differentiated neuroendocrine tumor, WHO grade 2 (G2), stage IIIB. This article reports the diagnosis and treatment of a rectal neuroendocrine neoplasm metastasis to the thyroid. There is autoimmunity to the thyroid glandwhich bears both humoral- and cell-mediated features. doi:10.1007/s12022-017-9475-6, 17. However, as the patient was only three months post-rectal cancer surgery and had a significant reaction to chemotherapy, she was extremely weak. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. The most common cause, or attacker, is an autoimmune disease, which is the result of your immune system accidentally attacking your body instead of protecting it. Rojo-Abecia M, Rivera-Alonso D, Herrero-lvarez S, Ochagava-Cmara S, Torres-Garca AJ. BMC Cancer (2018) 18(1):146. doi:10.1186/s12885-018-4054-x, 19. Heterogeneous thyroid echotexture | Radiology Reference Article doi:10.1007/s40618-020-01282-w, 14. Can someone tell me what this means? The most common site of occurrence is the gastrointestinal tract, and rectal NENs are more common in Asian people. J-YD: Formal analysis, Resources, Data Curation. Primary tumors lodging in the inferior thyroid pole involve both the central and the inferior lateral (supraclavicular) lymph nodes.29 Oncologically, the ipsilateral and contralateral lateral neck represents a therapeutic watershed. WebThe thyroid gland produces 2 related hormones, thyroxine (T4) and triiodothyronine (T3). The high oxygen saturation and high iodine content of the thyroid gland are not conducive to the growth of cancer cells. These basic lesions lead to changes in the thyroid microenvironment, which may create favorable conditions for the growth of metastatic cancer cells. The isthums is 0.4 cm with a 0.7 cm isoechoic nodule seen. Wang X, Huang Y, Zheng Z, Cao W, Chen B, Wang X. Metastases to the thyroid gland: a retrospective analysis of 21 patients[J]. Riedel thyroiditis requires surgical treatment. World J Clin cases (2020) 8(19):458894. What Does It Mean If Your Thyroid Is Heterogeneous? The hemorrhage was caus-ing mild mass effect on the subglottic tra-chea with substernal extension into the upper mediastinum. In this paper, preoperative FNAC indicated the possibility of malignancy, which provided an important basis for clinical decision-making. Heterogenous means that the thyroid is diverse in character. Homogenous means it's all the same I'm not sure why the uptake and scan would have been opposite, unless things changed between the time you had them how far apart did you have them? How long between the time you were hypo and when you were hyper? heterogeneous "The thyroid parenchyma" is the main part of your thyroid gland. This will likely involve antibiotics. Thyroiditis generally isnt life-threatening. NENs are rare and highly heterogeneous tumors originating from neuroendocrine organs or cells. Correlate with thyroid function studies as needed: Real time imaging of the thyroid gland was performed. Ghossein CA, Khimraj A, Dogan S, Xu B. Metastasis to the thyroid gland: a single-institution 16-year experience[J]. Most scholars believe that to achieve local neck control or even a cure, surgical treatment is the priority for patients whose thyroid is the only site of metastasis and whose primary cancer can be resected and cured (1517). The prognosis (outlook) for thyroiditis is generally good. BMC Cancer. What is the meaning of thyroid is diffusely heterogeneous in echotexture? Thyroid gland enlargement is usually diffuse and symmetric. Thyroid nodules. Color Doppler shows an unremarkable flow patatern throughout the thyroid gland. Radiol Clin North Am. WebThe vast majority more than 95% of thyroid nodules are benign (noncancerous). It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. (B) Metastatic neuroendocrine tumor without normal thyroid tissue (HE; 400X). If you have any questions about thyroiditis or your treatment plan, talk to your healthcare provider. BMJ Case Rep (2018) 2018:bcr2018225549. thyroid Heterogeneity: Heterogeneous means the size is irregular in terms of thickness throughout. No nodules were seen. Moreover, swollen and hard lymph nodes could be palpated on both sides of the neck, with a maximum size of approximately 2.0*1.0 cm. Homogeneous echotexture is normal for thyroids. Thyroid glands are diffusely heterogeneous with generalized increased vasculanity? It's unclear why your immune system does this. Factors associated with prognosis include the type of primary tumor (20) and the occurrence time, number, size, and location of the metastatic tumors (25). Ann Surg Oncol (2017) 24(6):15339. . Decreased ability to concentrate and focus. Nixon IJ, Coca-Pelaz A, Kaleva AI, Triantafyllou A, Angelos P, Owen RP, et al. Hashimoto's thyroiditis is the most common type. Youll likely have to take the medication for approximately six to 12 months and then taper off it to see if you have permanent hypothyroidism or not. Doctors typically provide answers within 24 hours. doi:10.1089/thy.2007.0343, 25. It sounds as though you most likely have an enlargement of the thyroid called a goiter. HT may show as poorly defined, patchy hypoechoic areas and micronodular patterns consisting of Thyroiditis is inflammation of your thyroid gland. Herpes spreads by oral, vaginal and anal sex. Epidemiologic trends of and factors associated with overall survival for patients with gastroenteropancreatic neuroendocrine tumors in the united States[J]. doi:10.1002/cncy.21494, 15. Color Doppler ultrasound (Figure1) and computed tomography (CT) showed multiple nodules with increased signals in the bilateral lobes of the patients thyroid; among them, the largest nodule on the right side was 2.0*2.0 cm and the largest nodule on the left side was 1.0*1.5 cm. What does diffusely enlarged heterogeneous thyroid gland mean? Call back and ask. Since the patient had no other distant metastatic lesions, we performed bilateral total thyroidectomy + bilateral central lymph node dissection on October 31, 2018. Pusztaszeri M, Wang H, Cibas ES, Powers CN, Bongiovanni M, Ali S, et al. Most types of thyroiditis cause thyrotoxicosis symptoms followed by hypothyroid symptoms. If an abscess forms on your thyroid, your provider may need to drain the fluid and pus with fine-needle aspiration (needle biopsy). Antibodies that attack your thyroid cause most types of thyroiditis. It is no longer the time to disregard thyroid metastases from breast cancer: a case report and review of the literature[J]. FINDINGS: Right and left lobes of thyroid measure 5.1 x 1.8 x 1.9 cm and 4.6 x 1.3 x 1.6 cm respectively. 3. Therefore, it is recommended that regular and timely general examinations be conducted after the discovery of TM and that the frequency of examinations should be increased. Sonography of diffuse thyroid disease - Wiley Online Library Moreover, the TMs in this patient were from a rectal neuroendocrine tumor, which is different from previous reports; thus, this case report has certain significance as a reference (9). The thyroid gland is diffusely heterogeneous and hypervascular. If youre experiencing these symptoms, call 911 or get to the nearest hospital as soon as possible. No inflammation of thyroid tissue is present; the overall size of thyroid within normal limits about 11 cu cm; three solid nodules are reflecting less ultrasound waves then surrounding tissue, they can be monitored for growth [by follow up ultrasound in 6 to 12 months}. 2013;17(2):219-27. TM has an insidious onset and often has no obvious clinical symptoms. The faster blood flow in the thyroid prevents the adhesion of cancer cells. We tapped the CDC for information on what you need to know about radiation exposure, Endocrinologist Mark Lupo, MD, answers 10 questions about thyroid disorders and how to treat them. Diffusely heterogeneous thyroid gland | HealthTap Online Doctor Figure3 Histological findings of a rectal neuroendocrine tumor metastasized to the thyroid. Thyroid metastases from colorectal cancer 14 years later: a case report and literature review[J]. (B) HE staining demonstrated typical neuroendocrine tumor morphology (HE; 400X). I know I should wait to see the doctor, but I picked up my own results. Feeling agitated, irritable and/or anxious. Treatment options include thyroid hormone medication, radioactive iodine therapy and surgery. For example, Stergianos S (21) reported that the survival rate of TM patients was higher when the primary tumor was renal cell carcinoma, versus other types of primary tumors. . Oxaliplatin 130 mg D1+ S-1 60 mg d1-7 (SOX), anlotinib, irinotecan 260 mg d1 q2w and other drugs were used successively. Most scholars believe that the prognosis of TM is generally poor. Mattavelli F, Collini P, Pizzi N, Gervasoni C, Pennacchioli E, Mazzaferro V. Thyroid as a target of metastases. If your thyroid cells are damaged and thyroid hormone levels fall, you might experience the symptoms of hypothyroidism, which include: Thyroiditis is caused by an attack on your thyroid, causing inflammation (your bodys response to an injury) and damage to the thyroid cells. No deiscfete nodule or cyst in the left lobe is seen. (A) Ultrasound showed that there was an isoechoic nodule in the right lobe of the patient, with a size of approximately 2*2 cm, a regular shape, and an uneven halo around the edge. Thyroid Nodules doi:10.1089/thy.2014.0498, 27. Therefore, the patient came to our hospital for further examination In September 2018, the patient came to the clinic after experiencing neck pain without other obvious discomfort. The thyroid gland is homogeneous in echotexture. Thyroid peroxidase antibodies: Markers of thyroid autoimmunity. The patient underwent regular follow-up after surgery. WebThe various causes of diffuse thyroid disease often have overlapping sonographic imaging features. Common causes of an inflamed thyroid include autoimmune thyroiditis (also called Hashimoto's thyroiditis), which occurs when the person's immune system attacks its own thyroid, causing swelling and inflammation. Further inquiries can be directed to the corresponding author. Nonshivering thermogenesis: Shunting of energy from substrate (fat, glucose) to heat; driven by the uncoupling protein-1 in brown fat. If you have acute infectious thyroiditis, the infection will need to be treated. Thyroid hormone absorption: The acidic stomach environment promotes this process, and calcium and iron inhibit it. Can you help me interpret my ultrasound report? Connect with a U.S. board-certified doctor by text or video anytime, anywhere. J Cancer Res Ther (2018) 14(7):15158. Some studies suggest that more than 50 percent of the population may have a thyroid nodule. Thyroiditis: Types, Causes, Symptoms, Diagnosis & Treatment For example, not getting enough iodine in the diet can cause changes in hormone levels and lead to a goiter. However, there was no basic thyroid disease in this patient, so the cause of metastasis in this patient needs to be further explored. Lymph node metastases limited to the ipsilateral lateral compartment denote localized disease amenable to surgical cure by systematic neck dissection. From: Surgery of the Thyroid and Parathyroid Glands (Third Edition), 2021, In Diagnostic Pathology: Intraoperative Consultation (Second Edition), 2018, Parathyroid parenchyma can resemble thyroid parenchyma, Pseudofollicular and trabecular structures can be present, Pseudofollicles can contain eosinophilic material that simulates colloid, Oxyphilic cells can resemble Hrthle cell nodule of thyroid, Features helpful to identify true parathyroid parenchyma, Cells smaller and more vacuolated than thyroid cells, Nuclei have rounder and denser chromatin than thyroid nuclei, Lack birefringent and polarizable calcium oxalate crystals seen in thyroid, Pseudofollicles can contain material that closely mimics colloid, Thyroid parenchyma can resemble parathyroid parenchyma, Stromal edema or ice crystal artifact can simulate adipose tissue, Rarely, true adipose metaplasia can be present within thyroid tissue, Hrthle cells of thyroid can be mistaken for oxyphil cells, True thyroid follicles often contain calcium oxalate crystals that are easily seen with polarization, Calcium oxalate crystals are not seen in parathyroid tissue, Ice crystal artifact can mimic adipose tissue within lymph node and mimic parathyroid gland, Parathyroid tissue has more cytoplasm than lymphocytes, Assessing cellularity in small biopsies can be difficult, Variable within parathyroid glands and among glands in single individual, Polar regions of parathyroid more cellular than central, Cellularity increases with age and varies with gender, ethnicity, and body habitus, In Imaging Anatomy: Ultrasound (Second Edition), 2018, Normal thyroid parenchyma has fine, uniform echoes and is hyperechoic compared to adjacent muscles, Echogenic thyroid capsule is clearly visualized and helps to differentiate thyroid lesions from extrathyroidal masses, Both longitudinal and transverse scans are required for comprehensive ultrasound assessment of thyroid gland, Transverse scan helps to locate thyroid nodules, their relationship to trachea, major vessels in carotid sheath, and to evaluate internal architecture and extrathyroid extension, Longitudinal scan helps to evaluate internal architecture, vascularity on Doppler, and extrathyroidal extension, Assessment of adjacent structures (including trachea, esophagus, strap muscles, carotid artery, and internal jugular vein) and cervical lymph nodes, In Diagnostic Pathology: Head and Neck (Second Edition), 2016, Destruction and replacement of thyroid parenchyma by dense collagen (keloid-like bands of fibrosis), Fibrosing process is not confined to thyroid but also involves extrathyroidal connective tissue structures, such as, Muscle, adipose tissue, nerves, and vascular spaces, In addition to fibrosis, chronic inflammatory cell infiltrate is present, Predominantly composed of mature plasma cells and lymphocytes; eosinophils may be present, Vasculitis is present primarily involving veins (phlebitis) characterized by adventitial inflammation that may invade through full thickness of vessel wall with thrombotic effect, May be readily apparent or may be difficult to identify; not present in all cases, Remnant of thyroid follicles may be present (but may be difficult to identify), Not associated with oxyphilic metaplasia (as seen in chronic lymphocytic thyroiditis) or granulomatous inflammation, In some cases, preexisting or coexisting lesions may be present, e.g., adenomatoid nodule(s), follicular adenoma, follicular carcinoma, thyroid papillary carcinoma, Vania Nos MD, PhD, in Diagnostic Pathology: Endocrine (Second Edition), 2018, Reactive histologic features present in thyroid parenchyma, Absence of follicular cells within needle tract in addition to other reactive features indicates PFNAC, Cells with reactive atypia may become dislodged into vessels mimicking appearance of vascular invasion, Andreas Machens MD, PhD, Henning Dralle MD, PhD, in Advances in Treatment and Management in Surgical Endocrinology, 2020, Invasive growth emerges from within the thyroid parenchyma (extrathyroidal extension) or from within the lymphatic mesenchyma (extranodal growth).26 Two types of locoregional soft tissue infiltrates are to be distinguished: (1) by direct extension of, and/or venous microembolization from, a primary tumor penetrating the thyroid capsule, more commonly seen in the central neck; and (2) by growth of lymph node metastases through the nodal capsule, more often found in the lateral neck.27, Primary tumor size >20mm is independently associated with histology-proven lymph node recurrence.