Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, 6 Founders Building, Philadelphia, PA, 19104, USA.
Endocr Pathol. 2023 Mar;34(1):48-56. doi: 10.1007/s12022-023-09749-1. Epub 2023 Feb 1.
The effects of many pharmacological agents on thyroid function are well known. Direct influences on measurements of thyroid function tests are also described. However, certain classes of drugs produce morphological changes in the gland. This review focuses on the significance of the following drug classes for the thyroid pathologist: iodine, antithyroid drugs, psychotropic drugs, antibiotics, cardiotropic drugs, antidiabetic drugs, and immunomodulatory agents. Radioactive iodine initially induces mild histologic changes; however, the long-term effects include marked follicular atrophy, fibrosis, and nuclear atypia-changes that vary depending on the pre-therapy condition of the gland. Some psychotropic drugs have been associated with a spectrum of inflammatory changes throughout the gland. The tetracycline class of antibiotics, namely minocycline, can lead to a grossly black thyroid gland with pigment seen in both colloid and follicular epithelial cells while variably present within thyroid nodules. The surgical pathologist most commonly sees an amiodarone-affected gland removed for hyperthyroidism, and the histologic findings again depend on the pre-therapy condition of the gland. While GLP-1 receptor agonists carry an FDA black box warning for patients with a personal or family history of multiple endocrine neoplasia or medullary thyroid carcinoma, the C cell hyperplasia originally noted in rats has not borne out in human studies. Finally, thyroiditis and hypothyroidism are well known complications of checkpoint inhibitor therapy, and rare cases of severe thyroiditis requiring urgent thyroidectomy have been reported with unique histologic findings. In this review, we describe the histologic findings for these drugs and more, in many cases including their functional consequences.
许多药理制剂对甲状腺功能的影响是众所周知的。甲状腺功能测试的直接影响也有描述。然而，某些类别的药物会导致腺体的形态变化。本综述重点介绍以下几类药物对甲状腺病理学家的意义：碘、抗甲状腺药物、精神药物、抗生素、心脏药物、抗糖尿病药物和免疫调节剂。放射性碘最初会引起轻微的组织学变化；然而，长期影响包括明显的滤泡萎缩、纤维化和核异型性——这些变化因腺体的治疗前状况而异。一些精神药物与整个腺体的一系列炎症变化有关。四环素类抗生素，即米诺环素，可导致甲状腺明显变黑，胶体和滤泡上皮细胞中均可见到色素，而甲状腺结节内也存在不同程度的色素。外科病理学家最常看到因甲亢而切除的受胺碘酮影响的腺体，其组织学发现再次取决于腺体的治疗前状况。虽然 GLP-1 受体激动剂因其个人或家族多发性内分泌肿瘤或甲状腺髓样癌病史而被 FDA 列为黑框警告，但最初在大鼠中观察到的 C 细胞增生并未在人类研究中得到证实。最后，甲状腺炎和甲状腺功能减退症是检查点抑制剂治疗的已知并发症，已有罕见的严重甲状腺炎需要紧急甲状腺切除术的病例报告，并伴有独特的组织学发现。在本综述中，我们描述了这些药物及更多药物的组织学发现，在许多情况下还包括其功能后果。
