Silent thyroiditis: a histologic and immunohistochemical study

Twenty-six specimens obtained from 23 patients with clinically and laboratory-proven silent thyroiditis were examined histologically; 11 specimens were obtained during the thyrotoxic phase, and 15 specimens during the early or late recovery phase. All specimens showed chronic thyroiditis, focal or diffuse type; and lymphoid follicles were present in about half of the specimens. Most specimens showed neither stromal fibrosis nor oxyphilic cell changes. The follicular disruptions, which varied from moderate to severe and involved nearly all the visible follicles, were characteristic and common histologic features of this disorder. Giant cells were present in about two thirds of specimens. Six of the 7 specimens taken during the late recovery phase showed no follicular disruption. In 3 patients who had follow-up biopsies, the histologic involvement in the initial biopsy specimens clearly had disappeared in the second biopsy specimens. These histologic features indicate that silent thyroiditis may be a form of chronic thyroiditis, i.e., "chronic thyroiditis with marked follicular destruction." Thyroid biopsy is recommended as a useful tool in differentiating this disease from other thyroid diseases causing hyperthyroidism. In addition to the histologic analysis, intrathyroidal lymphocyte subsets were examined immunohistochemically and compared to those in chronic thyroiditis (Hashimoto's thyroiditis). In both silent and chronic thyroiditis, a great majority of lymphocytes infiltrating between thyroid follicles showed a T-cell phenotype, and no significant differences in T-cell and B-cell distribution between the diseases were observed.