Graves病甲状腺の病理組織像について

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Histopathologic studies were carried out on the thyroid tissues extirpated from 118 patients with Graves' disease at Ito hospital principally in 1977. The primary purposes of this study were to obtain the whole spectrum of histologic features of the thyroid tissues in Graves' disease and further to gain an insight into the precise clinical pictures of individual patients before, at and, if possible, after the operation. Numerical assessment as expressed in terms of percentage in area was undertaken for each of 17 histopathologic findings which were selected under a functio-morphologic viewpoint and in consideration of generally accepted pathlogic findings for Graves' disease or its related diseases. These findings included characteristics of follicles, height and folding of follicular epithelium, degenerative changes of epithelial cells etc.. For cluster analysis, the Ward's method was successfully performed using assessment values of these findings. The resulting dendrogram showed seven groups (I, II1, II2, II3, II4, III1and III2). This grouping may be considered multifaceted, because it was arrived at by analyzing values of a number of histologic parameters. These values were also analyzed by the principle factor analysis method, and five factors were extracted. The obtained contribution rate of the first factor was 23.5%, the second 16.8% and the third 10.1%. Besed on the factor loading values calculated for each of these factors, the first factor (F-1) was interpreted to represent “inflammation factor”, the second (F-2) “epithelium proliferation factor” and the third (F-3) “cell degeneration factor”. Concerning these factors, the factor loading scores were calculated for 118 cases and plotted on the two-dimensional planes formed by F-1 and F-2 and also by F-1 and F-3 in an attempt to visualize their general distribution pattern with respect to the histopathologic picture. In general, cases of the 7 groups by the cluster analysis occupied their respective regions on these planes. To grasp the clinico-pathologic correlation, duration of clinical course, serum antithyroid antibodies, preoperatively administered antithyroid drugs, and thyroid function were respectively grouped into a couple of classes. Each case as mapped on the factor plane showed a tendency to assemble as a group according to the clinical picture. Small follicles lined by hyperplastic epithelium were frequently encountered in the cases of short duration, i.e. within six months prior to the operation, while large follicles encircled by flattened epithelium with a large amount of colloid were predominant in the cases of long duration exceeding six months. It was surprising to note that large follicles containing much colloid were often observed in cases with high levels of serum T3, T4, whereas it is generally accepted that a typical histologic finding associated with hyperthyroidism is the preponderance of follicles lined by high columnar cells and with a scant amount of colloid. Some of these patients with high levels of serum T3, T4 had been administered iodine drugs before the operation. The possibility can not completely be ruled out that a part of this association is merely spurious due to the potential dual effect of iodine, one exerting on thyroid histology to make it quiescent, the other exerting on serum hormone levels to elevate them. Postoperative hypothyroidism frequently occurred in patients extirpated of a thyroid gland which consisted of small follicles accompanied by infiltration with lymphocytes and plasmacytes and moreover by formation of lymph follicles. Many of these patients with inflammatory findings in the thyroid gland had antithyroid antibodies in their sera. These findings may support the idea of categorizing a new entity called Hashitoxicosis. However,
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Graves病甲状腺の病理組織像について

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