Diagnosis of chronic lymphocytic thyroiditis (nodular presentation) by needle aspiration

Needle aspiration was performed on 40 patients with a diagnosis of chronic lymphocytic thyroiditis, and the cytologic findings are described. Clinically, 32 patients had a nodular lesion or lesions, and 8 had diffuse enlargement of the thyroid. A 20-ml glass syringe and an 18-gauge needle were used to aspirate the lesions, and smears were stained according to the Wright-Giemsa technique. Diagnostic material was obtained in 36 patients, and in 4 the aspirate was unsatisfactory. There was good correlation between cytologic findings and antibody tests. Thirteen patients underwent surgical excision of the lesions, and the diagnosis was confirmed histologically. In one patient, the histopathologic diagnosis was chronic lymphocytic thyroiditis and thyroid adenoma. The latter component was not recognized initially on the cytologic specimen. The abundant cellular material obtained in the early nodular forms may correspond to a cellular phase of the disease as opposed to a later fibrotic phase. The evaluation of the epithelial-lymphoid ratio is stressed, and substantial alteration of this ratio may suggest an association of chronic lymphocytic thyroiditis with other thyroid lesions, benign or malignant.