A Statistical Study of the Clinical Significance of Lymphocytic and Fibrocytic Replacements in the Hyperplastic Thyroid Gland*†

RELATIVELY little is known concerning the significance of lymphocytic and fibrocytic replacement in the hyperplastic thyroid gland (1). Thyroiditis has been studied in detail as an independent clinical and pathologic entity (2–4); the association of thyroiditis and exophthalmic goiter in the same patient, however, has received scant attention (5–8). It has been assumed that lymphocytic replacement and fibrocytic replacement of the hyperplastic parenchyma are related in some way to reduction in the intensity of the disease but their relationship to specific clinical signs and symptoms has not been extensively investigated (9). One year before Parry established exophthalmic goiter as a definite clinical entity in 1825, Conradi (10, 11) distinguished between inflammation of the goitrous gland, the so-called strumitis of later writers, and inflammation of the previously normal gland. Between 1825 and 1914 lymphocytes and fibrous tissue in the hyperplastic thyroid gland attracted the attention of numerous workers, including Kocher (12), Berry (13), Lewis (14), MacCallum (15) and others (16, 17). It was not until Brüinger's (report (18) of 2 cases in 1914, however, that thyroiditis in exophthalmic goiter became recognized as a definite entity. Plummer (19) in 1923 reported 2 cases of exophthalmic goiter, in both of which chronic thyroiditis was found on microscopic examination of resected tissue. In both cases myxedema later developed. Searls and Bartlett (3) in 1926 presented their criteria for distinguishing between thyroiditis and thyroiditis in exophthalmic goiter. Smith, Pool and Olcott (20) in 1934 noted the similarity between the lymphoid tissue in exophthalmic goiter and that of struma lymphomatosa. Broders (21) in 1936 pointed out that varying degrees of fibrous and lymphocytic infiltration are present in all cases of exophthalmic goiter. Hellwig (22) in 1939 concluded that histologic changes characteristic of so-called lymphadenoid goiter are occasionally found in thyroid glands resected because of exophthalmic goiter.