Determine the type of surgery performed: lobectomy, lobectomy + isthmusectomy, total thyroidectomy.
Using the requisition form, the electronic medical record, or the submitting physician, determine the reason for the procedure: goiter, single nodule, inflammatory process, abnormal results on fine needle aspiration. Learn the clinical location of any suspicious lesions.
Weigh and measure (three dimensions) the entire specimen.
Examine the external surface (color, smoothness of capsule/tumor extension) and overall shape (oval, nodular). Note the presence of attached soft tissue (fat, muscle, parathyroid glands, lymph nodes).
Orient the specimen, especially in total thyroidectomies. Posterior surface is flat or concave.
Blot dry and ink the outer surface. One ink color is usually sufficient; however, it may be helpful to use different colors for anterior and posterior to retain orientation. Blot dry or spray with alcohol.
Serially section at 5 mm intervals across the short axis, preserving the attachment of the capsule to the parenchyma in each slice.
Describe the cut surface, including areas of nodularity (single vs. multiple, measurements, encapsulation, color, texture, cystic vs. solid, papillary, calcification, hemorrhage, necrosis) and surrounding parenchyma (color, firm vs. soft, fibrosis). Measure the distance of suspicious nodules to the resection margin (or capsule if total thyroidectomy).
Perform touch preps on solitary nodules which are received without fixative.
Take photographs if:
Tumor greater than 5 cm in diameter.
Tumor extending outside the thyroid gland.
Tumor in a patient less than 30 years of age.
Thyroid gland greater than 100 gm (or lobe greater than 75 gm).
Non-tumoral condition (e.g. thyroiditis): five blocks from each lobe; one section from isthmus.
Tumor or nodular glands:
Include adjacent uninvolved thyroid, thyroid capsule, and tumor capsule in sections.
Multinodular gland: one to three blocks per nodule, depending on nodule size, up to five nodules.
Solitary encapsulated nodule without gross capsular invasion: ten blocks or entire nodule (whichever is less). Also submit three blocks of uninvolved gland and entire resection margin (if it is a hemithyroidectomy, submit a shave margin of the isthmus).
Solitary encapsulated nodule suspicious for capsular or vascular invasion: submit nodule entirely. Also submit three blocks of uninvolved gland and entire resection margin.
Solitary, obviously invasive nodule, not papillary carcinoma: five blocks of tumor including areas of invasion. Also submit three blocks of uninvolved gland and entire resection margin.
Papillary carcinoma: submit entire thyroid gland.
Entirely submit parathyroid glands and lymph nodes, if present.
Received without fixative/in formalin, labeled _____ and “_____”, is a _____ (left, right) thyroid _____ (lobectomy, lobectomy + isthmusectomy)/total thyroidectomy weighing __ g and measuring __ x __ x __ cm. The external surface is _____ (color, encapsulation, rough vs. smooth, shape). The cut surface has multiple (color, texture) nodules ranging from __ to __ cm in diameter throughout the gland. There is a _____ (color, encapsulation, texture, cystic vs. solid, papillary, calcified, hemorrhagic, necrotic) nodule measuring __ x __ x __ cm in the _____ pole of the _____ lobe/isthmus. It is __ cm from the resection margin and does/does not extend to the external surface of the thyroid. The uninvolved thyroid parenchyma is _____ (describe). There is an attached piece of tan-brown soft tissue along the _____ surface of the left/right _____ pole measuring __ x __ x __ cm, resembling parathyroid/lymph node/muscle. Photographs are taken. Touch preps are prepared. Representatively submitted as follows:
#__ - #__ = solitary nodule
#__ - #__ = diffuse nodules, one section per nodule