Tuberculosis of the thyroid gland mimicking carcinoma

Primary tuberculosis of thyroid gland: a rare case report

Tuberculosis of the thyroid gland is a rare entity, and primary tuberculosis of thyroid is even uncommon. At one time, it was believed that thyroid gland is relatively immune to tuberculosis. There are about 200 cases of thyroid tuberculosis that had been reported in world literature. These include 156 cases reviewed by Goldfarb et al (Am J Med 1965;38:825) and 1 each by Crompton et al (Tubercle 1969;50:61-64), Johnson et al (Br J Surg 1973;60:668-669), Emry (J Laryngol Otol 1980;94:553-558), and Kukreja and Sharma ML (Ind J Surg 1982;44:190-192), and a histologic diagnosis by Das et al (Acta Cytol 1992;36:517-522) and Mondal and Patra (J Laryngol Otol 1995;109:36-38). Almost all cases had primary foci elsewhere in the body. Isolated tuberculosis of the thyroid gland is extremely rare, with few reported cases; when it does occur, it may prove difficult to diagnose (J Laryngol Otol 1980;94:553-558). Among the different manifestations of tuberculous thyroiditis, abscess of the thyroid appears to be the rarest and the most dangerous (Tubercle 1969;50:61-64). Sachs et al (Am J Med 1988;85:573-575) reported 4 cases of tuberculous thyroiditis that were diagnosed preoperatively, the rest of the cases were diagnosed either from surgical specimen or from autopsy. A case of primary tuberculosis of thyroid gland presenting as abscess and diagnosed preoperatively is reported here.

Primary thyroid tuberculosis

In India, it is estimated that more than 40% of the adults are infected with tuberculosis bacilli and every year 2 million people develop tuberculosis and nearly 500,000 die from it1. But, tuberculosis of the thyroid gland occurs only rarely. Since extra-pulmonary tuberculosis is now seen relatively more frequently, the existence of this condition should be recognized when goitres are being treated. We present a case of right thyroid nodule associated with low grade fever and weight loss. No signs and symptoms of hypothyroidism or hyperthyroidism were present. Patient did not have any other tuberculosis focus. Routine investigation and chest X-ray were normal. Sputum for Acid Fast Bacilli was negative. Fine Needle Aspiration Cytology and Contrast Enhanced Computed Tomography led to a diagnosis of Primary Thyroid Tuberculosis in a euthyroid patient. Patient responded well to Anti tubercular Drug Therapy along with repeated aspiration.

Tuberculosis of the Thyroid Gland: Review of the Literature

OBJECTIVE

Thyroid tuberculosis (TTB) is a very rare condition, even in countries with a high prevalence of tuberculosis. The aim of this article is to review and retrieve data about thyroid tuberculosis from the English-language literature in order to gain a better understanding of the clinical characteristics of TTB.

STUDY DESIGN

We performed Medline, PubMed, and library searches using the key words "thyroid tuberculosis," "throid disease," "tuberculosis and thyroid." Reference lists of the articles obtained and previous reviews were also examined.

RESULTS

We retrieved 76 cases matching our selection criteria from the search. Review of the cases with TTB revealed a slight female preponderance. The patients reported in the literature ranged in age from 9 to 83 years, with a median age of 40+/-16 years for men and 44+/-17 years for women. In the articles surveyed, TTB presented with a broad spectrum of manifestations, ranging from an isolated nodule to thyrotoxicosis. It seems that diagnosis of thyroid tuberculosis has recently been increasing, perhaps because of the growing incidence of tuberculosis and the diagnostic use of fine-needle aspiration cytology in the diagnosis. Although, in the past, the diagnosis was generally made by the examination of the specimens, at present, fine-needle aspiration cytology seems to be a useful method in diagnosis tuberculous thyroiditis. The role of surgery is limited after the diagnosis. The choice of treatment should be medical antituberculous therapy.

CONCLUSIONS

Preoperative diagnosis of thyroid tuberculosis is important because of the availability of medical treatment and the limited role of surgery. This condition should be kept in mind in evaluating patients with a thyroid nodule, in communities where the prevalence of tuberculosis is high.

Sonographic findings of tuberculous thyroiditis in a patient with Behçet's syndrome

We report a case of tuberculous thyroiditis in a woman with Behçet's syndrome. The initial physical examination in May 1998 revealed multiple soft, nontender, mobile lymph nodes, each measuring less than 1 cm, in the left lower internal jugular chain. Sonography performed in February 2000 showed multiple small (< 1 cm), oval lymph nodes, each with an intact fatty hilum, in the left lower internal jugular chain; the thyroid gland appeared normal. Follow-up sonography 6 months later showed multifocal, heterogeneous, hypoechoic lesions with ill-defined margins in both lobes of the thyroid and several small, oval lymph nodes, each with an intact fatty hilum, in the left lower internal jugular chain. Fine-needle aspiration was performed on the largest thyroid lesion, and cytologic analysis of the aspirate revealed a small number of epithelioid histiocytes in a necrotic background, which was suggestive of tuberculosis. Follow-up sonography after 3 months of antituberculosis chemotherapy showed that the thyroid lesions had resolved.

Tuberculous anterior neck mass simulating goitre

A 13-year-old Saudi boy was referred to the paediatric endocrinology clinic for evaluation of rapidly progressive goitre with weight loss of 6 months duration. A clinical diagnosis of possible thyroid malignancy was made. On exploration the mass was found to be tuberculous in origin, attached to the thyroid gland, and responded to partial excision and anti-tuberculous chemotherapy. Tuberculosis should be considered in the differential diagnosis of anterior midline neck masses.

Efficacy of fine needle aspiration cytology in the diagnosis of tuberculosis of the thyroid gland: a study of 18 cases

Tuberculosis of the thyroid gland is an extremely rare condition. Amongst 1565 cases of thyroid lesions subjected to fine needle aspiration cytology (FNAC) over a period of nine years, 18 cases (1.15 per cent) were found to have cytological features consistent with tuberculosis thyroiditis. Acid-fast bacilli were isolated in all cases. The ages of the patients ranged from 36 to 52 years with a median age of 46 years: there were 12 females and 6 males. All the patients presented with painless solitary nodules of the thyroid. Three patients had concomitant cervical lympadenopathy and four patients were known to have tuberculosis of the lungs which was being treated. Solitary nodules of the thyroid were confirmed by a thyroid scan with radioactive iodine. Fine needle aspirates from thyroid swellings showed epithelioid granulomas with necrosis in all cases. There were no false reports or complications. It is evident from this study that FNAC is an efficient way with which to detect tuberculosis of the thyroid gland.

Tuberculosis of the thyroid gland: a clinicopathological profile of four cases and review of the literature

Four cases of tuberculosis of the thyroid with different presentations including chronic sinus (following drainage of thyroid abscess), thyrotoxicosis, severe dysphagia clinically mimicking malignancy and euthyroid multinodular goitre are described. Except in the case presenting with chronic sinus (discharging acid-fast bacilli), the diagnosis was a pathological surprise (cytopathology in one and histopathology in two). Only in one case was there evidence of disease outside the cervical region. All cases showed multiple coalescing and caseating epitheloid cell granulomas along with giant cells, which are considered as diagnostic of tuberculous thyroiditis even if acid fast bacilli cannot be demonstrated. The literature is reviewed and the pathogenesis discussed.

Tuberculosis of the thyroid bed presenting as recurrent medullary thyroid carcinoma

A 69-year-old lady with previous medullary thyroid carcinoma treated by total thyroidectomy alone developed a swelling in the neck. This was thought to be a recurrence of her carcinoma but was found on investigation to be a tuberculous abscess of the thyroid bed. She was treated successfully by surgical drainage and antituberculous chemotherapy.

Thyroid tuberculosis associated with mediastinal lymphadenitis

A 25-year-old man developed thyroid tuberculosis associated with mediastinal lymph node enlargement. He was treated by antituberculosis chemotherapy and hemithyroidectomy.

Tuberculosis of the thyroid gland associated with thyrotoxicosis

Tuberculosis of the thyroid gland is rare. A case of tuberculosis of the thyroid gland associated with thyrotoxicosis is reported.

Acute tuberculous abscess of the thyroid gland

A case is reported of acute tuberculous abscess of the thyroid gland in a young woman. The rarity of this presentation is discussed in the context of the other forms of tuberculous thyroiditis.