INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)

ISSN No. 2454-6194 | DOI: 10.51584/IJRIAS |Volume X Issue XI November 2025

Hashimoto Thyroiditis Presenting as Long-Standing Neck Swelling:A

Case Report With Review of Literature

Nanda Patil¹, Drashti Maradiya²

¹²Department of Pathology, Krishna Institute of Medical Science, Krishna Vishwa Vidyapeeth Karad,

Maharashtra, India.

*Correspondence Author

DOI: https://doi.org/10.51584/IJRIAS.2025.101100053

Received: 21 November 2025; Accepted: 28 November 2025; Published: 11 December 2025

ABSTRACT

Background

Hashimoto thyroiditis is an autoimmune disorder characterized by gradual destruction of thyroid follicular

cells,leading to progressive hypothyroidism. It is the most common cause of thyroid dysfunction in iodine-

sufficient regions and shows marked female predominance. Surgical evaluation is required when malignancy

cannot be excluded.

Case Report

A 35 year old female presented with a slowly progressive swelling on right anterior neck for 8 years. She was a

known case of hypothyroidism and was on medication. Histopathological examination on total thyroidectomy

specimenconfirmed Hashimoto thyroiditis.

Conclusion

Hashimotothyroiditis presents in young individuals with long-standing goiters that can mimic neoplastic

lesions.Surgical intervention is required in cases with compressive symptoms.Early recognition and

appropriate evaluation are essential for accurate diagnosis and effective management.

Keywords:Hashimoto thyroiditis, Hypothyroid, Long standing neck swelling.

INTRODUCTION

Hashimoto thyroiditis is a chronic autoimmune disorder in which ongoing immune-mediated injury

progressively destroys thyroid follicular cells. This process is driven by a cell-mediated immune response and

increased production of thyroid autoantibodies [1]. In iodine-sufficient regions, it represents the most frequent

cause ofhypothyroidism. The condition is distinctly more common in females [2].

We report a case of Hashimoto thyroiditis in a 35-year-old woman with eight-year history of midline neck

swelling.

Case Report

A 35-year-old female presented with history of midline neck swelling. She was a known case of

hypothyroidism and was taking Tab. Eltroxin. She additionally reported irritability, tiredness.

Ultrasonography of the thyroid revealed a hypoechoic lesion measuring 59 × 25 × 36 mm in the right

lobe(Figure 1). Serum T4 and TSH levels were within normal limits as patient was on hypothyroid treatment.

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INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)

ISSN No. 2454-6194 | DOI: 10.51584/IJRIAS |Volume X Issue XI November 2025

FNAC performed at an outside center yielded a diagnosis of atypia of undetermined significance (AUS),

Bethesda category III.

Figure 1: Ultrasonography of the thyroid revealed a hypoechoic lesion

A total thyroidectomy specimen was received for histopathological examination. Grossly, the thyroid gland

appeared grey-brown, encapsulated, and slightly irregular on its external surface. The right lobe measured 7.5

× 4 × 2.6 cm and showed a grey-brown, nodular, waxy cut surface. The left lobe measured 3 × 1.5 × 0.5 cm,

and theisthmus measured 1.2 × 1 × 0.4 cm

Figure 2: Enlarged thyroid gland, on c/s- nodular and waxy

Microscopy demonstrated diffuse lymphocytic infiltration of the thyroid parenchyma with multiple well-

formed germinal centers. Thyroid follicles were atrophic and lined by Askanazy cells. The stroma exhibited

variable degrees of fibrosis. These findings were consistent with Hashimoto thyroiditis.

One month post-operative follow up of patient is uneventful.

Figure 3:Microscopy revealed lymphoid follicles replacing normal thyroid parenchyma( 100X H&E)

Figure 4:Microscopy revealed atrophic thyroid follicles lined by Askanazy cells( 100X H&E)

Figure 3

Figure 4

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INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN APPLIED SCIENCE (IJRIAS)

ISSN No. 2454-6194 | DOI: 10.51584/IJRIAS |Volume X Issue XI November 2025

DISCUSSION

Hashimoto thyroiditis commonly affects women, with reported female-to-male ratio ranging from 7:1 to 10:1

[3]. Our case was also a 35-year-old female. The incidence of Hashimoto thyroiditis increases with age,

typically between 45 and 55 years, although younger individuals, as in this case, may also be affected [3].

Genetic influences play an important role, with several susceptibility loci involving the HLA complex,

immune-regulatory genes, and thyroid-specific genes such as the TSH receptor and thyroglobulin [4-5]. The

disease is more frequently observed in individuals with Turner syndrome and Down syndrome [6-7]. However,

our patient had no associated syndromic history.

Depending on the severity of thyroid enlargement, patients may present with compressive symptoms such as

dysphagia, respiratory difficulty, stridor, or dysphonia due to involvement of the esophagus or trachea. When

ultrasonography reveals suspicious nodularity, fine-needle aspiration cytology (FNAC) is typically

recommended, and thyroidectomy may be performed if malignancy cannot be excluded [8-9].

Elevated thyroid autoantibodies correlate with disease activity [10]. Thyroid ultrasonography is helpful for

assessing gland enlargement and nodularity. FNAC is routinely used for evaluation of suspicious lesions but

may occasionally yield false-negative or indeterminate results, as in our case.

Histopathology remains the definitive diagnostic method, characteristically showing lymphocytic infiltration,

follicular destruction, plasma cells, macrophages, and occasionally multinucleated giant cells and atrophic

follicles lined by Askanazy cells [11]. Although many patients remain euthyroid initially, they have an

increased risk of developing overt hypothyroidism, with an estimated progression rate of about 5% per year

[12].Hashimoto thyroiditis are at risk for a rare thyroid malignancy: primary thyroid lymphoma [3]. Thyroid

peroxidise antibody and Thyroglobulin antibody are most Common antibodies found in Hashimoto thyroiditis,

however these tests were not done in our case as the patient was not able to afford them [13]. The relation

between HT and thyroid epithelial cancers is controversial, with some molecular and morphological studies

suggesting a predisposition to papillary carcinoma [14].

CONCLUSION

Hashimoto thyroiditis presents in young individuals with long-standing goitersthat can mimic neoplastic

lesions. Surgical intervention is required in cases with compressive symptoms. Early recognition and

appropriate evaluation are essential for accurate diagnosis and effective management. A combined clinical,

imaging, and pathological approach ensures accurate diagnosis and appropriate management, especially in

younger patients with atypical or prolonged presentations.

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