An Overview of the Thyroid Gland and Thyroid-Related Deaths for the Forensic Pathologist

Abstract

The thyroid gland is a butterfly-shaped organ situated in the anterior neck whose functions have system-wide effects. Thyroid diseases represent some of the most commonly encountered endocrine disorders and therefore are commonly encountered at the time of autopsy. Knowing how the gland functions and the effects it may have on vital organs is important when determining the cause of death and significant contributory conditions. Endocrine-related deaths may be anatomically subtle, therefore histologic examination, review of medical records, and selected postmortem testing must be performed to correctly identify and document their presence. For this reason, it is recommended that pathologists consider regularly examining the thyroid gland histologically, particularly on decedents where no apparent anatomic cause of death is identified after the autopsy. This article provides an in-depth review of the thyroid gland, thyroid hormones, and thyroid diseases, including potential thyroid-related deaths and incidental autopsy findings.

Keywords: Forensic pathology; Postmortem thyroid hormone; Thyroid cancer; Thyroid gland; Thyrotoxicosis.

Image 1:

Diffusely and symmetrically enlarged thyroid gland weighing 125 g.

Image 2:

Colloid-filled follicles with papillae (Sanderson's polsters) (H&E, x100).

Image 3:

Scalloping in colloid filled follicles (H&E, x400).

Image 4:

Thyroid gland, status post ablation treatment (H&E, x100).

Image 5:

Colloid nodule with small focus of papillary thyroid carcinoma (white nodule in center).

Image 6:

Nuclear features of papillary thyroid carcinoma. Nuclear grooves are represented with the thin arrows and a nuclear pseudoinclusion is represented by the larger open arrow. Normal thyroid follicular cells are to the left of the image (H&E, x400).

Image 7:

Follicular variant of papillary thyroid carcinoma (left) adjacent to normal thyroid parenchyma (right) (H&E, x100).

Image 8:

Nuclear features of follicular variant of papillary thyroid carcinoma with nuclear grooves (thin arrow) and pseudoinclusion (open arrow) (H&E, x400).

Image 9:

Solitary thyroid nodule.

Image 10:

Firm, atrophic thyroid gland.

Image 11:

Cut sections of firm atrophic thyroid gland.

Image 12:

Thyroid parenchyma infiltrated by lymphocytes and reactive follicles (H&E, x40).

Image 13:

Black thyroid gland due to minocycline therapy.