J.Jpn. Surg. Soc.. 60(5): 874-890, 1959
THE CLINICAL AND PATHOLOGICAL STUDIES ON HASHIMOTO'S STRUMA
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First Surgical Department, Tokyo University School of Medicine (Director : Prof . K. Schimizu) Tomikazu MASUDA |
2) Clinical symptoms (frequence, age, sex, history, size and consistence of struma, compressing signs, basal metabolic rate and findings at operation) were in accordance with those of Hashimoto's struma described in other literatures. Adhesions to the surrounding tissues beyond the capsule was not observed in any these cases, including four cases with history of struma for longer than 10 years.
3) Pathologic changes in Hashimoto's struma were varied markedly in these severity. According to the changes in epithelial celIs of thyroid follicles, the severity was classified into the initial, intermediate and late stages. In th initial stage, diffuse or local aggregation of lymphocytes and lymph follicle formation were found among the normal thyroid follicles. Destructed thyroid follicles and their epithelial cells were observed, being surrounded by lymphcytic aggregation. In the intermediate stage, epithelial cell was eosinophilic and appeared similar to the Hiirthle cell, and no normal thyroid follicles were found. In the late stage, not only the follicles but the epithelial cells were destroied and replaced by remarkable proliferation of the connective tissue. The transitional forms were frequently seen among these three stages. The pathological characteristics of Hashimoto's struma are the maintenance of the lobular structure even until the late stage and the Hürthle cell-like change of the epithelial cell.
4) The administration of a large amount of TSH (Thyroid stimulating hormon) in a short period in guinea-pigs caused the Hürthle cell-like change and the subsequent destruction of the epithelial cells.
5) Hashimoto's struma is considered to be a different entity of disease from that of Riedel's thyroiditis, from the facts, the absences of adhesion beyond the capsule, the maintenance of the lobular structure and Hürthle cell-like change of epithelial cells.
6) According to the clinical symptoms and a few remaining epithelial cells, Riedel's thyroiditis is considered to be transformed from de Quervain's thyroiditis.
7) The presence of antibody against the thyroid extract was investigated in 33 cases of thyroid diseases and also in healthy persons as control. Five out of six cases of Hashimoto's struma were observed to be positive and these pathological pictures belonged to the late stage.
(author's abstract)
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