Nodular follicular disease

by Jason Wasserman MD PhD FRCPC
November 22, 2022

What is nodular follicular disease?

Nodular follicular disease is a non-cancerous type of growth involving the thyroid gland. The abnormal growth can affect one-half of the gland (one lobe) or the entire gland (both lobes and the isthmus). It is the most common cause of nodules in the thyroid gland.

Other names for this condition include follicular nodular disease, nodular thyroid disease, nodular thyroid hyperplasia, and adenomatous hyperplasia. Non-pathologists use the word goiter to describe the changes caused by nodular follicular disease.

Anatomy thyroid gland

What are the symptoms of nodular follicular disease?

Patients with nodular follicular disease may notice a lump in their thyroid gland or that their entire thyroid gland is enlarged. Doctors call these lumps thyroid nodules. The lumps typically do not cause pain although very large nodules may cause discomfort by putting pressure on surrounding structures.

How is this diagnosis made?

The diagnosis of nodular follicular disease can be made after part or all of the thyroid gland is surgically removed and sent to a pathologist for examination. The examination involves looking at the thyroid gland with and without a microscope. When examined without a microscope, the thyroid gland looks larger than normal and light-colored nodules can be seen replacing the normal dark brown thyroid tissue.

What does nodular follicular disease look like under the microscope?

When examined under the microscope, nodular follicular disease is made up of abnormal follicles that range in size from small to very large. The growth causes the thyroid gland to become divided into small round nodules. The follicular cells in these abnormal follicles look very similar to the follicular cells in the normal thyroid gland.

Nodular follicular disease
Nodular follicular disease

What is an adenomatoid nodule?

Some pathology reports will use the word adenomatoid to describe the nodules seen in nodular follicular disease. Adenomatoid means that the nodules looked similar to a non-cancerous type of growth called a follicular adenoma. Unlike follicular adenomas, adenomatoid nodules are not completely surrounded and separated from the normal thyroid tissue by a thin layer of tissue called a capsule. The word dominant is used to describe the largest adenomatoid nodule.

What are degenerative changes?

A thyroid gland that is enlarged as a result of nodular follicular disease will show signs of injury that pathologists describe as degenerative change. When examined under the microscope these changes include hemosiderin (old blood), fibrosis (scar), and the development of small open spaces called cysts.

What does fine needle aspiration-like changes mean?

If you had a procedure called a fine-needle aspiration biopsy (FNAB) performed prior to having your thyroid gland removed, your pathologist will be able to see the changes caused by the needle when the tissue is examined under the microscope. These changes usually include bleeding and the formation of a scar along the path of the needle. If your pathologist is unsure if you had an FNA performed before the thyroid gland was removed, they may describe these changes as “FNA-like”.

What does reactive atypia mean?

Pathologists use the term “reactive atypia” to describe follicular cells that are abnormal in shape, size, or colour as a result of inflammation or injury caused by a prior fine-needle aspiration biopsy (FNAB). Reactive atypia is a non-cancerous change that is commonly seen in a thyroid gland with nodular follicular disease.

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