Fine needle aspiration biopsy. Tests for autoimmune problems and antimicrosomal antibodies. Surgery is not usually necessary in this disease. The disease is an autoimmune inflammatory disorder. It is thought that there may be a defect in suppressor T cell activity that allows persistence of sensitized clones of antithyroid lymphocytes allowing cytotoxic T cell attacks on follicular cells and allowing T helper cell participation in formation of autoantibodies such as those directed against the TSH receptor, thyroid microsomes, thyroglobulin, T3, T4 and follicular cell membranes.
Papillary carcinoma is the diagnosis.
Papillary architecture, and nuclear features including ground glass appearance, intranuclear pseudoinclusins, and longitudinal grooving. It is the most frequent form of thyroid carcinoma. Extra-nodal extension, poorly differentiated histology, older age of patient, and long duration of disease are factors that worsen the prognosis. Patients with diffuse nontoxic or simple goiters are hypothyroid. Patients with multinodular goiter may be nontoxic or be associated with thyrotoxicosis.